1862 
quirement before the first day of the first calendar 
quarter beginning after the close of the first regular 
session of the State legislature that begins after the 
date of the enactment of this Act. For purposes of 
the previous sentence, in the case of a State that has 
a 2-year legislative session, each year of such session 
shall be deemed to be a separate regular session of 
the State legislature. 
SEC. 1757. MEDICAID AND CHIP EXCLUSION FROM PARTICI-
PATION RELATING TO CERTAIN OWNERSHIP, 
CONTROL, AND MANAGEMENT AFFILIATIONS. 
(a) STATE PLAN REQUIREMENT.—Section 1902(a) 
of the Social Security Act (42 U.S.C. 1396a(a)), as 
amended by sections 1631(b)(1), 1703, and 1753, is fur-
ther amended— 
(1) in paragraph (75), by striking at the end 
‘‘and’’; 
(2) in paragraph (76), by striking at the end 
the period and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (76) the fol-
lowing new paragraph: 
‘‘(77) provide that the State agency described 
in paragraph (9) exclude, with respect to a period, 
any individual or entity from participation in the 
program under the State plan if such individual or 
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entity owns, controls, or manages an entity that (or 
if such entity is owned, controlled, or managed by an 
individual or entity that)— 
‘‘(A) has unpaid overpayments under this 
title during such period determined by the Sec-
retary or the State agency to be delinquent; 
‘‘(B) is suspended or excluded from par-
ticipation under or whose participation is termi-
nated under this title during such period; or 
‘‘(C) is affiliated with an individual or enti-
ty that has been suspended or excluded from 
participation under this title or whose participa-
tion is terminated under this title during such 
period.’’. 
(b) CHILD HEALTH PLAN REQUIREMENT.—Section 
2107(e)(1)(A) of such Act (42 U.S.C. 1397gg(e)(1)(A)), 
as amended by section 1756(b), is amended by striking 
‘‘section 
1902(a)(39)’’ 
and 
inserting 
‘‘sections 
1902(a)(39) and 1902(a)(77)’’. 
(c) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to 
services furnished on or after January 1, 2011, 
without regard to whether or not final regulations to 
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carry out such amendments have been promulgated 
by such date. 
(2) In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
or a child health plan under title XXI of such Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, the State plan or 
child health plan shall not be regarded as failing to 
comply with the requirements of such title solely on 
the basis of its failure to meet this additional re-
quirement before the first day of the first calendar 
quarter beginning after the close of the first regular 
session of the State legislature that begins after the 
date of the enactment of this Act. For purposes of 
the previous sentence, in the case of a State that has 
a 2-year legislative session, each year of such session 
shall be deemed to be a separate regular session of 
the State legislature. 
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SEC. 1758. REQUIREMENT TO REPORT EXPANDED SET OF 
DATA ELEMENTS UNDER MMIS TO DETECT 
FRAUD AND ABUSE. 
Section 1903(r)(1)(F) of the Social Security Act (42 
U.S.C. 1396b(r)(1)(F)) is amended by inserting after 
‘‘necessary’’ the following: ‘‘and including, for data sub-
mitted to the Secretary on or after July 1, 2010, data 
elements from the automated data system that the Sec-
retary determines to be necessary for detection of waste, 
fraud, and abuse’’. 
SEC. 1759. BILLING AGENTS, CLEARINGHOUSES, OR OTHER 
ALTERNATE PAYEES REQUIRED TO REG-
ISTER UNDER MEDICAID. 
(a) IN GENERAL.—Section 1902(a) of the Social Se-
curity Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended 
by sections 1631(b), 1703, 1753, and 1757, is further 
amended— 
(1) in paragraph (76); by striking at the end 
‘‘and’’; 
(2) in paragraph (77), by striking the period at 
the end and inserting ‘‘and’’; and 
(3) by inserting after paragraph (77) the fol-
lowing new paragraph: 
‘‘(78) provide that any agent, clearinghouse, or 
other alternate payee that submits claims on behalf 
of a health care provider must register with the 
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State and the Secretary in a form and manner speci-
fied by the Secretary under section 1866(j)(1)(D).’’. 
(b) DENIAL OF PAYMENT.—Section 1903(i) of such 
Act (42 U.S.C. 1396b(i)), as amended by section 1753, 
is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(24); 
(2) by striking the period at the end of para-
graph (25) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (25) the fol-
lowing new paragraph: 
‘‘(26) with respect to any amount paid to a bill-
ing agent, clearinghouse, or other alternate payee 
that is not registered with the State and the Sec-
retary as required under section 1902(a)(78).’’. 
(c) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to 
claims submitted on or after January 1, 2012, with-
out regard to whether or not final regulations to 
carry out such amendments have been promulgated 
by such date. 
(2) In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
which the Secretary of Health and Human Services 
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determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, the State plan or 
child health plan shall not be regarded as failing to 
comply with the requirements of such title solely on 
the basis of its failure to meet this additional re-
quirement before the first day of the first calendar 
quarter beginning after the close of the first regular 
session of the State legislature that begins after the 
date of the enactment of this Act. For purposes of 
the previous sentence, in the case of a State that has 
a 2-year legislative session, each year of such session 
shall be deemed to be a separate regular session of 
the State legislature. 
SEC. 1760. DENIAL OF PAYMENTS FOR LITIGATION-RE-
LATED MISCONDUCT. 
(a) IN GENERAL.—Section 1903(i) of the Social Se-
curity Act (42 U.S.C. 1396b(i)), as previously amended 
is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(25); 
(2) by striking the period at the end of para-
graph (26) and inserting a semicolon; and 
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(3) by inserting after paragraph (26) the fol-
lowing new paragraphs: 
‘‘(27) with respect to any amount expended— 
‘‘(A) on litigation in which a court imposes 
sanctions on the State, its employees, or its 
counsel for litigation-related misconduct; or 
‘‘(B) to reimburse (or otherwise com-
pensate) a managed care entity for payment of 
legal expenses associated with any action in 
which a court imposes sanctions on the man-
aged care entity for litigation-related mis-
conduct.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to amounts expended on or after 
January 1, 2010. 
Subtitle G—Puerto Rico and the 
Territories 
SEC. 1771. PUERTO RICO AND TERRITORIES. 
(a) INCREASE IN CAP.— 
(1) IN GENERAL.—Section 1108(g) of the So-
cial Security Act (42 U.S.C. 1308(g)) is amended— 
(A) in paragraph (4) by striking ‘‘and (3)’’ 
and by inserting ‘‘(3), (6), and (7)’’; and 
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(B) by inserting after paragraph (5), as 
added by section 1731(d), the following new 
paragraph: 
‘‘(6) FISCAL YEARS 2011 THROUGH 2019.—The 
amounts otherwise determined under this subsection 
for Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, and American Samoa for 
fiscal year 2011 and each succeeding fiscal year 
through fiscal year 2019 shall be increased by the 
percentage specified under section 1771(c) of the 
America’s Affordable Health Choices Act of 2009 
for purposes of this paragraph of the amounts other-
wise determined under this section (without regard 
to this paragraph). 
‘‘(7) FISCAL YEAR 2020 AND SUBSEQUENT FIS-
CAL
YEARS.—The amounts otherwise determined 
under this subsection for Puerto Rico, the Virgin Is-
lands, Guam, the Northern Mariana Islands, and 
American Samoa for fiscal year 2020 and each suc-
ceeding fiscal year shall be the amount provided in 
paragraph (6) or this paragraph for the preceding 
fiscal year for the respective territory increased by 
the percentage increase referred to in paragraph 
(1)(B), rounded to the nearest $10,000 (or 
$100,000 in the case of Puerto Rico).’’. 
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(2) 
COORDINATION
WITH
ARRA.—Section 
5001(d) of the American Recovery and Reinvestment 
Act of 2009 shall not apply during any period for 
which section 1108(g)(6) of the Social Security Act, 
as added by paragraph (1), applies. 
(b) INCREASE IN FMAP.— 
(1) IN GENERAL.—Section 1905(b)(2) of the 
Social Security Act (42 U.S.C. 1396d(b)(2)) is 
amended by striking ‘‘50 per centum’’ and inserting 
‘‘for fiscal years 2011 through 2019, the percentage 
specified under section 1771(c) of the America’s Af-
fordable Health Choices Act of 2009 for purposes of 
this clause for such fiscal year and for subsequent 
fiscal years the percentage so specified for fiscal 
year 2019’’. 
(2) EFFECTIVE DATE.—The amendment made 
by subsection (a) shall apply to items and services 
furnished on or after October 1, 2010. 
(c) SPECIFICATION
OF PERCENTAGES.—The Sec-
retary of Health and Human Services shall specify, before 
January 1, 2011, the percentages to be applied under sec-
tion 1108(g)(6) of the Social Security Act, as added by 
subsection (a)(1), and under section 1905(b)(2) of such 
Act, as amended by subsection (b)(1), in a manner so that 
for the period beginning with 2011 and ending with 2019 
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the total estimated additional Federal expenditures result-
ing from the application of such percentages will be equal 
to $10,350,000,000. 
Subtitle H—Miscellaneous 
SEC. 1781. TECHNICAL CORRECTIONS. 
(a) TECHNICAL CORRECTION TO SECTION 1144 OF 
THE SOCIAL SECURITY ACT.—The first sentence of sec-
tion 1144(c)(3) of the Social Security Act (42 U.S.C. 
1320b—14(c)(3)) is amended— 
(1) by striking ‘‘transmittal’’; and 
(2) by inserting before the period the following: 
‘‘as specified in section 1935(a)(4)’’. 
(b) CLARIFYING AMENDMENT TO SECTION 1935 OF 
THE SOCIAL SECURITY ACT.—Section 1935(a)(4) of the 
Social Security Act (42 U.S.C. 1396u—5(a)(4)), as 
amended by section 113(b) of Public Law 110–275, is 
amended— 
(1) by striking the second sentence; 
(2) by redesignating the first sentence as a sub-
paragraph (A) with appropriate indentation and 
with the following heading: ‘‘IN GENERAL’’; 
(3) by adding at the end the following subpara-
graphs: 
‘‘(B) FURNISHING
MEDICAL
ASSISTANCE 
WITH
REASONABLE
PROMPTNESS.—For the 
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purpose of a State’s obligation under section 
1902(a)(8) to furnish medical assistance with 
reasonable promptness, the date of the elec-
tronic transmission of low-income subsidy pro-
gram data, as described in section 1144(c), 
from the Commissioner of Social Security to the 
State Medicaid Agency, shall constitute the date 
of filing of such application for benefits under 
the Medicare Savings Program. 
‘‘(C) 
DETERMINING
AVAILABILITY
OF 
MEDICAL ASSISTANCE.—For the purpose of de-
termining when medical assistance will be made 
available, the State shall consider the date of 
the individual’s application for the low income 
subsidy program to constitute the date of filing 
for benefits under the Medicare Savings Pro-
gram.’’. 
(c) EFFECTIVE
DATE
RELATING
TO
MEDICAID 
AGENCY CONSIDERATION OF LOW-INCOME SUBSIDY AP-
PLICATION AND DATA TRANSMITTAL.—The amendments 
made by subsections (a) and (b) shall be effective as if 
included in the enactment of section 113(b) of Public Law 
110–275. 
(d) TECHNICAL CORRECTION TO SECTION 605 OF 
CHIPRA.—Section 605 of the Children’s Health Insur-
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(1) by striking ‘‘sections 1933 and’’ and by in-
serting ‘‘section’’; and 
(2) by striking ‘‘December 2010’’ and inserting 
‘‘December 2012’’. 
(b) ELIMINATION OF FUNDING LIMITATION.— 
(1) IN GENERAL.—Section 1933 of such Act 
(42 U.S.C. 1396u–3) is amended— 
(A) in subsection (a), by striking ‘‘who are 
selected to receive such assistance under sub-
section (b)’’; 
(B) by striking subsections (b), (c), (e), 
and (g); 
(C) in subsection (d), by striking ‘‘fur-
nished in a State’’ and all that follows and in-
serting ‘‘the Federal medical assistance percent-
age shall be equal to 100 percent.’’; and 
(D) by redesignating subsections (d) and 
(f) as subsections (b) and (c), respectively. 
(2) 
CONFORMING
AMENDMENT.—Section 
1905(b) of such Act (42 U.S.C. 1396d(b)) is amend-
ed by striking ‘‘1933(d)’’ and inserting ‘‘1933(b)’’. 
(3) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect on January 1, 
2011. 
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TITLE P—REVENUE-RELATED 
PROVISIONS 
SEC. 1801. DISCLOSURES TO FACILITATE IDENTIFICATION 
OF INDIVIDUALS LIKELY TO BE INELIGIBLE 
FOR THE LOW-INCOME ASSISTANCE UNDER 
THE MEDICARE PRESCRIPTION DRUG PRO-
GRAM TO ASSIST SOCIAL SECURITY ADMINIS-
TRATION’S OUTREACH TO ELIGIBLE INDIVID-
UALS. 
(a) IN GENERAL.—Paragraph (19) of section 6103(l) 
of the Internal Revenue Code of 1986 is amended to read 
as follows: 
‘‘(19) DISCLOSURES
TO
FACILITATE
IDENTI-
FICATION
OF
INDIVIDUALS
LIKELY
TO
BE
INELI-
GIBLE FOR LOW-INCOME SUBSIDIES UNDER MEDI-
CARE PRESCRIPTION DRUG PROGRAM TO ASSIST SO-
CIAL
SECURITY
ADMINISTRATION’S
OUTREACH
TO 
ELIGIBLE INDIVIDUALS.— 
‘‘(A) IN GENERAL.—Upon written request 
from the Commissioner of Social Security, the 
following return information (including such in-
formation disclosed to the Social Security Ad-
ministration under paragraph (1) or (5)) shall 
be disclosed to officers and employees of the So-
cial Security Administration, with respect to 
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any taxpayer identified by the Commissioner of 
Social Security— 
‘‘(i) return information for the appli-
cable year from returns with respect to 
wages (as defined in section 3121(a) or 
3401(a)) and payments of retirement in-
come (as described in paragraph (1) of this 
subsection), 
‘‘(ii) unearned income information 
and income information of the taxpayer 
from partnerships, trusts, estates, and sub-
chapter S corporations for the applicable 
year, 
‘‘(iii) if the individual filed an income 
tax return for the applicable year, the fil-
ing status, number of dependents, income 
from farming, and income from self-em-
ployment, on such return, 
‘‘(iv) if the individual is a married in-
dividual filing a separate return for the ap-
plicable year, the social security number (if 
reasonably available) of the spouse on such 
return, 
‘‘(v) if the individual files a joint re-
turn for the applicable year, the social se-
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curity number, unearned income informa-
tion, and income information from partner-
ships, trusts, estates, and subchapter S 
corporations of the individual’s spouse on 
such return, and 
‘‘(vi) such other return information 
relating to the individual (or the individ-
ual’s spouse in the case of a joint return) 
as is prescribed by the Secretary by regula-
tion as might indicate that the individual 
is likely to be ineligible for a low-income 
prescription drug subsidy under section 
1860D–14 of the Social Security Act. 
‘‘(B) APPLICABLE
YEAR.—For the pur-
poses of this paragraph, the term ‘applicable 
year’ means the most recent taxable year for 
which information is available in the Internal 
Revenue Service’s taxpayer information records. 
‘‘(C) RESTRICTION ON INDIVIDUALS FOR 
WHOM DISCLOSURE MAY BE REQUESTED.—The 
Commissioner of Social Security shall request 
information under this paragraph only with re-
spect to— 
‘‘(i) individuals the Social Security 
Administration has identified, using all 
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other reasonably available information, as 
likely to be eligible for a low-income pre-
scription 
drug 
subsidy 
under 
section 
1860D–14 of the Social Security Act and 
who have not applied for such subsidy, and 
‘‘(ii) any individual the Social Security 
Administration has identified as a spouse 
of an individual described in clause (i). 
‘‘(D) RESTRICTION ON USE OF DISCLOSED 
INFORMATION.—Return information disclosed 
under this paragraph may be used only by offi-
cers and employees of the Social Security Ad-
ministration solely for purposes of identifying 
individuals likely to be ineligible for a low-in-
come prescription drug subsidy under section 
1860D–14 of the Social Security Act for use in 
outreach efforts under section 1144 of the So-
cial Security Act.’’. 
(b) SAFEGUARDS.—Paragraph (4) of section 6103(p) 
of such Code is amended— 
(1) by striking ‘‘(l)(19)’’ each place it appears, 
and 
(2) by striking ‘‘or (17)’’ each place it appears 
and inserting ‘‘(17), or (19)’’. 
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(c) CONFORMING AMENDMENT.—Paragraph (3) of 
section 6103(a) of such Code is amended by striking 
‘‘(19),’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to disclosures made after the date 
which is 12 months after the date of the enactment of 
this Act. 
SEC. 
1802. 
COMPARATIVE 
EFFECTIVENESS 
RESEARCH 
TRUST FUND; FINANCING FOR TRUST FUND. 
(a) ESTABLISHMENT OF TRUST FUND.— 
(1) IN GENERAL.—Subchapter A of chapter 98 
of the Internal Revenue Code of 1986 (relating to 
trust fund code) is amended by adding at the end 
the following new section: 
‘‘SEC. 9511. HEALTH CARE COMPARATIVE EFFECTIVENESS 
RESEARCH TRUST FUND. 
‘‘(a) CREATION OF TRUST FUND.—There is estab-
lished in the Treasury of the United States a trust fund 
to be known as the ‘Health Care Comparative Effective-
ness Research Trust Fund’ (hereinafter in this section re-
ferred to as the ‘CERTF’), consisting of such amounts 
as may be appropriated or credited to such Trust Fund 
as provided in this section and section 9602(b). 
‘‘(b) TRANSFERS TO FUND.—There are hereby ap-
propriated to the Trust Fund the following: 
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‘‘(1) For fiscal year 2010, $90,000,000. 
‘‘(2) For fiscal year 2011, $100,000,000. 
‘‘(3) For fiscal year 2012, $110,000,000. 
‘‘(4) For each fiscal year beginning with fiscal 
year 2013— 
‘‘(A) an amount equivalent to the net reve-
nues received in the Treasury from the fees im-
posed under subchapter B of chapter 34 (relat-
ing to fees on health insurance and self-insured 
plans) for such fiscal year; and 
‘‘(B) subject to subsection (c)(2), amounts 
determined by the Secretary of Health and 
Human Services to be equivalent to the fair 
share per capita amount computed under sub-
section (c)(1) for the fiscal year multiplied by 
the average number of individuals entitled to 
benefits under part A, or enrolled under part B, 
of title XVIII of the Social Security Act during 
such fiscal year. 
The amounts appropriated under paragraphs (1), (2), (3), 
and (4)(B) shall be transferred from the Federal Hospital 
Insurance Trust Fund and from the Federal Supple-
mentary Medical Insurance Trust Fund (established 
under section 1841 of such Act), and from the Medicare 
Prescription Drug Account within such Trust Fund, in 
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proportion (as estimated by the Secretary) to the total ex-
penditures during such fiscal year that are made under 
title XVIII of such Act from the respective trust fund or 
account. 
‘‘(c) FAIR SHARE PER CAPITA AMOUNT.— 
‘‘(1) COMPUTATION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the fair share per capita amount 
under this paragraph for a fiscal year (begin-
ning with fiscal year 2013) is an amount com-
puted by the Secretary of Health and Human 
Services for such fiscal year that, when applied 
under this section and subchapter B of chapter 
34 of the Internal Revenue Code of 1986, will 
result 
in 
revenues 
to 
the 
CERTF 
of 
$375,000,000 for the fiscal year. 
‘‘(B) ALTERNATIVE COMPUTATION.— 
‘‘(i) IN GENERAL.—If the Secretary is 
unable to compute the fair share per capita 
amount under subparagraph (A) for a fis-
cal year, the fair share per capita amount 
under this paragraph for the fiscal year 
shall be the default amount determined 
under clause (ii) for the fiscal year. 
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‘‘(ii) DEFAULT AMOUNT.—The default 
amount under this clause for— 
‘‘(I) fiscal year 2013 is equal to 
$2; or 
‘‘(II) a subsequent year is equal 
to the default amount under this 
clause for the preceding fiscal year in-
creased by the annual percentage in-
crease in the medical care component 
of the consumer price index (United 
States city average) for the 12-month 
period ending with April of the pre-
ceding fiscal year. 
Any amount determined under subclause 
(II) shall be rounded to the nearest penny. 
‘‘(2) LIMITATION ON MEDICARE FUNDING.—In 
no case shall the amount transferred under sub-
section (b)(4)(B) for any fiscal year exceed 
$90,000,000. 
‘‘(d) EXPENDITURES FROM FUND.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
amounts in the CERTF are available, without the 
need for further appropriations and without fiscal 
year limitation, to the Secretary of Health and 
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Human Services for carrying out section 1181 of the 
Social Security Act. 
‘‘(2) ALLOCATION FOR COMMISSION.—Not less 
than the following amounts in the CERTF for a fis-
cal year shall be available to carry out the activities 
of the Comparative Effectiveness Research Commis-
sion established under section 1181(b) of the Social 
Security Act for such fiscal year: 
‘‘(A) For fiscal year 2010, $7,000,000. 
‘‘(B) For fiscal year 2011, $9,000,000. 
‘‘(C) For each fiscal year beginning with 
2012, $10,000,000. 
Nothing in this paragraph shall be construed as pre-
venting additional amounts in the CERTF from 
being made available to the Comparative Effective-
ness Research Commission for such activities. 
‘‘(e) NET REVENUES.—For purposes of this section, 
the term ‘net revenues’ means the amount estimated by 
the Secretary based on the excess of— 
‘‘(1) the fees received in the Treasury under 
subchapter B of chapter 34, over 
‘‘(2) the decrease in the tax imposed by chapter 
1 resulting from the fees imposed by such sub-
chapter.’’. 
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(2) CLERICAL AMENDMENT.—The table of sec-
tions for such subchapter A is amended by adding 
at the end thereof the following new item: 
‘‘Sec. 9511. Health Care Comparative Effectiveness Research Trust Fund.’’. 
(b) FINANCING FOR FUND FROM FEES ON INSURED 
AND SELF-INSURED HEALTH PLANS.— 
(1) GENERAL RULE.—Chapter 34 of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new subchapter: 
‘‘Subchapter B—Insured and Self-Insured 
Health Plans 
‘‘Sec. 4375. Health insurance. 
‘‘Sec. 4376. Self-insured health plans. 
‘‘Sec. 4377. Definitions and special rules. 
‘‘SEC. 4375. HEALTH INSURANCE. 
‘‘(a) IMPOSITION OF FEE.—There is hereby imposed 
on each specified health insurance policy for each policy 
year a fee equal to the fair share per capita amount deter-
mined under section 9511(c)(1) multiplied by the average 
number of lives covered under the policy. 
‘‘(b) LIABILITY FOR FEE.—The fee imposed by sub-
section (a) shall be paid by the issuer of the policy. 
‘‘(c) SPECIFIED HEALTH INSURANCE POLICY.—For 
purposes of this section: 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this section, the term ‘specified health in-
surance policy’ means any accident or health insur-
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ance policy issued with respect to individuals resid-
ing in the United States. 
‘‘(2) EXEMPTION FOR CERTAIN POLICIES.—The 
term ‘specified health insurance policy’ does not in-
clude any insurance if substantially all of its cov-
erage is of excepted benefits described in section 
9832(c). 
‘‘(3) TREATMENT OF PREPAID HEALTH COV-
ERAGE ARRANGEMENTS.— 
‘‘(A) IN GENERAL.—In the case of any ar-
rangement described in subparagraph (B)— 
‘‘(i) such arrangement shall be treated 
as a specified health insurance policy, and 
‘‘(ii) the person referred to in such 
subparagraph shall be treated as the 
issuer. 
‘‘(B) DESCRIPTION OF ARRANGEMENTS.— 
An arrangement is described in this subpara-
graph if under such arrangement fixed pay-
ments or premiums are received as consider-
ation for any person’s agreement to provide or 
arrange for the provision of accident or health 
coverage to residents of the United States, re-
gardless of how such coverage is provided or ar-
ranged to be provided. 
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‘‘SEC. 4376. SELF-INSURED HEALTH PLANS. 
‘‘(a) IMPOSITION OF FEE.—In the case of any appli-
cable self-insured health plan for each plan year, there is 
hereby imposed a fee equal to the fair share per capita 
amount determined under section 9511(c)(1) multiplied by 
the average number of lives covered under the plan. 
‘‘(b) LIABILITY FOR FEE.— 
‘‘(1) IN GENERAL.—The fee imposed by sub-
section (a) shall be paid by the plan sponsor. 
‘‘(2) PLAN SPONSOR.—For purposes of para-
graph (1) the term ‘plan sponsor’ means— 
‘‘(A) the employer in the case of a plan es-
tablished or maintained by a single employer, 
‘‘(B) the employee organization in the case 
of a plan established or maintained by an em-
ployee organization, 
‘‘(C) in the case of— 
‘‘(i) a plan established or maintained 
by 2 or more employers or jointly by 1 or 
more employers and 1 or more employee 
organizations, 
‘‘(ii) a multiple employer welfare ar-
rangement, or 
‘‘(iii) a voluntary employees’ bene-
ficiary association described in section 
501(c)(9), 
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‘‘(E) by any organization described in sec-
tion 501(c)(6), or 
‘‘(F) in the case of a plan not described in 
the preceding subparagraphs, by a multiple em-
ployer welfare arrangement (as defined in sec-
tion 3(40) of Employee Retirement Income Se-
curity Act of 1974), a rural electric cooperative 
(as defined in section 3(40)(B)(iv) of such Act), 
or a rural telephone cooperative association (as 
defined in section 3(40)(B)(v) of such Act). 
‘‘SEC. 4377. DEFINITIONS AND SPECIAL RULES. 
‘‘(a) DEFINITIONS.—For purposes of this sub-
chapter— 
‘‘(1) ACCIDENT AND HEALTH COVERAGE.—The 
term ‘accident and health coverage’ means any cov-
erage which, if provided by an insurance policy, 
would cause such policy to be a specified health in-
surance policy (as defined in section 4375(c)). 
‘‘(2) INSURANCE POLICY.—The term ‘insurance 
policy’ means any policy or other instrument where-
by a contract of insurance is issued, renewed, or ex-
tended. 
‘‘(3) UNITED
STATES.—The term ‘United 
States’ includes any possession of the United States. 
‘‘(b) TREATMENT OF GOVERNMENTAL ENTITIES.— 
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‘‘(1) IN GENERAL.—For purposes of this sub-
chapter— 
‘‘(A) the term ‘person’ includes any gov-
ernmental entity, and 
‘‘(B) notwithstanding any other law or rule 
of law, governmental entities shall not be ex-
empt from the fees imposed by this subchapter 
except as provided in paragraph (2). 
‘‘(2) TREATMENT OF EXEMPT GOVERNMENTAL 
PROGRAMS.—In the case of an exempt governmental 
program, no fee shall be imposed under section 4375 
or section 4376 on any covered life under such pro-
gram. 
‘‘(3) EXEMPT
GOVERNMENTAL
PROGRAM
DE-
FINED.—For purposes of this subchapter, the term 
‘exempt governmental program’ means— 
‘‘(A) any insurance program established 
under title XVIII of the Social Security Act, 
‘‘(B) the medical assistance program es-
tablished by title XIX or XXI of the Social Se-
curity Act, 
‘‘(C) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to individuals (or 
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the spouses and dependents thereof) by reason 
of such individuals being— 
‘‘(i) members of the Armed Forces of 
the United States, or 
‘‘(ii) veterans, and 
‘‘(D) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to members of In-
dian tribes (as defined in section 4(d) of the In-
dian Health Care Improvement Act). 
‘‘(c) TREATMENT AS TAX.—For purposes of subtitle 
F, the fees imposed by this subchapter shall be treated 
as if they were taxes. 
‘‘(d) NO COVER OVER TO POSSESSIONS.—Notwith-
standing any other provision of law, no amount collected 
under this subchapter shall be covered over to any posses-
sion of the United States.’’. 
(2) CLERICAL AMENDMENTS.— 
(A) Chapter 34 of such Code is amended 
by striking the chapter heading and inserting 
the following: 
‘‘CHAPTER 34—TAXES ON CERTAIN 
INSURANCE POLICIES 
‘‘SUBCHAPTER A. POLICIES ISSUED BY FOREIGN INSURERS 
‘‘SUBCHAPTER B. INSURED AND SELF-INSURED HEALTH PLANS 
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‘‘Subchapter A—Policies Issued By Foreign 
Insurers’’. 
(B) The table of chapters for subtitle D of 
such Code is amended by striking the item re-
lating to chapter 34 and inserting the following 
new item: 
‘‘CHAPTER 34—TAXES ON CERTAIN INSURANCE POLICIES’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to policies 
and plans for portions of policy or plan years begin-
ning on or after October 1, 2012. 
TITLE Q—MISCELLANEOUS 
PROVISIONS 
SEC. 1901. REPEAL OF TRIGGER PROVISION. 
Subtitle A of title VIII of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Pub-
lic Law 108–173) is repealed and the provisions of law 
amended by such subtitle are restored as if such subtitle 
had never been enacted. 
SEC. 1902. REPEAL OF COMPARATIVE COST ADJUSTMENT 
(CCA) PROGRAM. 
Section 1860C–1 of the Social Security Act (42 
U.S.C. 1395w–29), as added by section 241(a) of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173), is repealed. 
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SEC. 1903. EXTENSION OF GAINSHARING DEMONSTRATION. 
(a) IN GENERAL.—Subsection (d)(3) of section 5007 
of the Deficit Reduction Act of 2005 (Public Law 109– 
171) is amended by inserting ‘‘(or September 30, 2011, 
in the case of a demonstration project in operation as of 
October 1, 2008)’’ after ‘‘December 31, 2009’’. 
(b) FUNDING.— 
(1) IN
GENERAL.—Subsection (f)(1) of such 
section is amended by inserting ‘‘and for fiscal year 
2010, $1,600,000,’’ after ‘‘$6,000,000,’’. 
(2) AVAILABILITY.—Subsection (f)(2) of such 
section is amended by striking ‘‘2010’’ and inserting 
‘‘2014 or until expended’’. 
(c) REPORTS.— 
(1) QUALITY
IMPROVEMENT
AND
SAVINGS.— 
Subsection (e)(3) of such section is amended by 
striking ‘‘December 1, 2008’’ and inserting ‘‘March 
31, 2011’’. 
(2) FINAL REPORT.—Subsection (e)(4) of such 
section is amended by striking ‘‘May 1, 2010’’ and 
inserting ‘‘March 31, 2013’’. 
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SEC. 1904. GRANTS TO STATES FOR QUALITY HOME VISITA-
TION PROGRAMS FOR FAMILIES WITH YOUNG 
CHILDREN AND FAMILIES EXPECTING CHIL-
DREN. 
Part B of title IV of the Social Security Act (42 
U.S.C. 621–629i) is amended by adding at the end the 
following: 
‘‘Subpart 3—Support for Quality Home Visitation 
Programs 
‘‘SEC. 440. HOME VISITATION PROGRAMS FOR FAMILIES 
WITH YOUNG CHILDREN AND FAMILIES EX-
PECTING CHILDREN. 
‘‘(a) PURPOSE.—The purpose of this section is to im-
prove the well-being, health, and development of children 
by enabling the establishment and expansion of high qual-
ity programs providing voluntary home visitation for fami-
lies with young children and families expecting children. 
‘‘(b) GRANT APPLICATION.—A State that desires to 
receive a grant under this section shall submit to the Sec-
retary for approval, at such time and in such manner as 
the Secretary may require, an application for the grant 
that includes the following: 
‘‘(1) DESCRIPTION OF HOME VISITATION PRO-
GRAMS.—A description of the high quality programs 
of home visitation for families with young children 
and families expecting children that will be sup-
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children in such States whose families have income 
that does not exceed 200 percent of the poverty line. 
‘‘(3) REALLOTMENTS.—The amount of any al-
lotment to a State under a paragraph of this sub-
section for any fiscal year that the State certifies to 
the Secretary will not be expended by the State pur-
suant to this section shall be available for reallot-
ment using the allotment methodology specified in 
that paragraph. Any amount so reallotted to a State 
is deemed part of the allotment of the State under 
this subsection. 
‘‘(d) MAINTENANCE OF EFFORT.—Beginning with 
fiscal year 2011, a State meets the requirement of this 
subsection for a fiscal year if the Secretary finds that the 
aggregate expenditures by the State from State and local 
sources for programs of home visitation for families with 
young children and families expecting children for the then 
preceding fiscal year was not less than 100 percent of such 
aggregate expenditures for the then 2nd preceding fiscal 
year. 
‘‘(e) PAYMENT OF GRANT.— 
‘‘(1) IN GENERAL.—The Secretary shall make a 
grant to each State that meets the requirements of 
subsections (b) and (d), if applicable, for a fiscal 
year for which funds are appropriated under sub-
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section (m), in an amount equal to the reimbursable 
percentage of the eligible expenditures of the State 
for the fiscal year, but not more than the amount 
allotted to the State under subsection (c) for the fis-
cal year. 
‘‘(2) REIMBURSABLE PERCENTAGE DEFINED.— 
In paragraph (1), the term ‘reimbursable percent-
age’ means, with respect to a fiscal year— 
‘‘(A) 85 percent, in the case of fiscal year 
2010; 
‘‘(B) 80 percent, in the case of fiscal year 
2011; or 
‘‘(C) 75 percent, in the case of fiscal year 
2012 and any succeeding fiscal year. 
‘‘(f) ELIGIBLE EXPENDITURES.— 
‘‘(1) IN GENERAL.—In this section, the term 
‘eligible expenditures’— 
‘‘(A) means expenditures to provide vol-
untary home visitation for as many families 
with young children (under the age of school 
entry) and families expecting children as prac-
ticable, through the implementation or expan-
sion of high quality home visitation programs 
that— 
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‘‘(i) adhere to clear evidence-based 
models of home visitation that have dem-
onstrated positive effects on important pro-
gram-determined child and parenting out-
comes, such as reducing abuse and neglect 
and improving child health and develop-
ment; 
‘‘(ii) employ well-trained and com-
petent staff, maintain high quality super-
vision, provide for ongoing training and 
professional development, and show strong 
organizational capacity to implement such 
a program; 
‘‘(iii) establish appropriate linkages 
and referrals to other community resources 
and supports; 
‘‘(iv) monitor fidelity of program im-
plementation to ensure that services are 
delivered according to the specified model; 
and 
‘‘(v) provide parents with— 
‘‘(I) knowledge of age-appro-
priate child development in cognitive, 
language, social, emotional, and motor 
domains (including knowledge of sec-
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ond language acquisition, in the case 
of English language learners); 
‘‘(II) knowledge of realistic ex-
pectations of age-appropriate child be-
haviors; 
‘‘(III) knowledge of health and 
wellness issues for children and par-
ents; 
‘‘(IV) modeling, consulting, and 
coaching on parenting practices; 
‘‘(V) skills to interact with their 
child to enhance age-appropriate de-
velopment; 
‘‘(VI) skills to recognize and seek 
help for issues related to health, devel-
opmental delays, and social, emo-
tional, and behavioral skills; and 
‘‘(VII) activities designed to help 
parents become full partners in the 
education of their children; 
‘‘(B) includes expenditures for training, 
technical assistance, and evaluations related to 
the programs; and 
‘‘(C) does not include any expenditure with 
respect to which a State has submitted a claim 
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for payment under any other provision of Fed-
eral law. 
‘‘(2) PRIORITY FUNDING FOR PROGRAMS WITH 
STRONGEST EVIDENCE.— 
‘‘(A) IN GENERAL.—The expenditures, de-
scribed in paragraph (1), of a State for a fiscal 
year that are attributable to the cost of pro-
grams that do not adhere to a model of home 
visitation with the strongest evidence of effec-
tiveness shall not be considered eligible expendi-
tures for the fiscal year to the extent that the 
total of the expenditures exceeds the applicable 
percentage for the fiscal year of the allotment 
of the State under subsection (c) for the fiscal 
year. 
‘‘(B) 
APPLICABLE
PERCENTAGE
DE-
FINED.—In subparagraph (A), the term ‘appli-
cable percentage’ means, with respect to a fiscal 
year— 
‘‘(i) 60 percent for fiscal year 2010; 
‘‘(ii) 55 percent for fiscal year 2011; 
‘‘(iii) 50 percent for fiscal year 2012; 
‘‘(iv) 45 percent for fiscal year 2013; 
or 
‘‘(v) 40 percent for fiscal year 2014. 
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‘‘(g) NO USE
OF OTHER FEDERAL FUNDS
FOR 
STATE MATCH.—A State to which a grant is made under 
this section may not expend any Federal funds to meet 
the State share of the cost of an eligible expenditure for 
which the State receives a payment under this section. 
‘‘(h) WAIVER AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary may waive 
or modify the application of any provision of this 
section, other than subsection (b) or (f), to an In-
dian tribe if the failure to do so would impose an 
undue burden on the Indian tribe. 
‘‘(2) SPECIAL
RULE.—An Indian tribe is 
deemed to meet the requirement of subsection (d) 
for purposes of subsections (c) and (e) if— 
‘‘(A) the Secretary waives the requirement; 
or 
‘‘(B) the Secretary modifies the require-
ment, and the Indian tribe meets the modified 
requirement. 
‘‘(i) STATE REPORTS.—Each State to which a grant 
is made under this section shall submit to the Secretary 
an annual report on the progress made by the State in 
addressing the purposes of this section. Each such report 
shall include a description of— 
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‘‘(1) the services delivered by the programs that 
received funds from the grant; 
‘‘(2) the characteristics of each such program, 
including information on the service model used by 
the program and the performance of the program; 
‘‘(3) the characteristics of the providers of serv-
ices through the program, including staff qualifica-
tions, work experience, and demographic characteris-
tics; 
‘‘(4) the characteristics of the recipients of serv-
ices provided through the program, including the 
number of the recipients, the demographic charac-
teristics of the recipients, and family retention; 
‘‘(5) the annual cost of implementing the pro-
gram, including the cost per family served under the 
program; 
‘‘(6) the outcomes experienced by recipients of 
services through the program; 
‘‘(7) the training and technical assistance pro-
vided to aid implementation of the program, and 
how the training and technical assistance contrib-
uted to the outcomes achieved through the program; 
‘‘(8) the indicators and methods used to mon-
itor whether the program is being implemented as 
designed; and 
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‘‘(9) other information as determined necessary 
by the Secretary. 
‘‘(j) EVALUATION.— 
‘‘(1) IN
GENERAL.—The Secretary shall, by 
grant or contract, provide for the conduct of an 
independent evaluation of the effectiveness of home 
visitation programs receiving funds provided under 
this section, which shall examine the following: 
‘‘(A) The effect of home visitation pro-
grams on child and parent outcomes, including 
child maltreatment, child health and develop-
ment, school readiness, and links to community 
services. 
‘‘(B) The effectiveness of home visitation 
programs on different populations, including 
the extent to which the ability of programs to 
improve outcomes varies across programs and 
populations. 
‘‘(2) REPORTS TO THE CONGRESS.— 
‘‘(A) INTERIM
REPORT.—Within 3 years 
after the date of the enactment of this section, 
the Secretary shall submit to the Congress an 
interim report on the evaluation conducted pur-
suant to paragraph (1). 
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‘‘(B) FINAL
REPORT.—Within 5 years 
after the date of the enactment of this section, 
the Secretary shall submit to the Congress a 
final report on the evaluation conducted pursu-
ant to paragraph (1). 
‘‘(k) ANNUAL REPORTS TO THE CONGRESS.—The 
Secretary shall submit annually to the Congress a report 
on the activities carried out using funds made available 
under this section, which shall include a description of the 
following: 
‘‘(1) The high need communities targeted by 
States for programs carried out under this section. 
‘‘(2) The service delivery models used in the 
programs receiving funds provided under this sec-
tion. 
‘‘(3) The characteristics of the programs, in-
cluding— 
‘‘(A) the qualifications and demographic 
characteristics of program staff; and 
‘‘(B) recipient characteristics including the 
number of families served, the demographic 
characteristics of the families served, and fam-
ily retention and duration of services. 
‘‘(4) The outcomes reported by the programs. 
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‘‘(5) The research-based instruction, materials, 
and activities being used in the activities funded 
under the grant. 
‘‘(6) The training and technical activities, in-
cluding on-going professional development, provided 
to the programs. 
‘‘(7) The annual costs of implementing the pro-
grams, including the cost per family served under 
the programs. 
‘‘(8) The indicators and methods used by States 
to monitor whether the programs are being been im-
plemented as designed. 
‘‘(l) RESERVATIONS OF FUNDS.—From the amounts 
appropriated for a fiscal year under subsection (m), the 
Secretary shall reserve— 
‘‘(1) an amount equal to 5 percent of the 
amounts to pay the cost of the evaluation provided 
for in subsection (j), and the provision to States of 
training and technical assistance, including the dis-
semination of best practices in early childhood home 
visitation; and 
‘‘(2) after making the reservation required by 
paragraph (1), an amount equal to 3 percent of the 
amount so appropriated, to pay for grants to Indian 
tribes under this section. 
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‘‘(m) APPROPRIATIONS.—Out of any money in the 
Treasury of the United States not otherwise appropriated, 
there is appropriated to the Secretary to carry out this 
section— 
‘‘(1) $50,000,000 for fiscal year 2010; 
‘‘(2) $100,000,000 for fiscal year 2011; 
‘‘(3) $150,000,000 for fiscal year 2012; 
‘‘(4) $200,000,000 for fiscal year 2013; and 
‘‘(5) $250,000,000 for fiscal year 2014. 
‘‘(n) INDIAN TRIBES TREATED AS STATES.—In this 
section, paragraphs (4), (5), and (6) of section 431(a) 
shall apply.’’. 
SEC. 1905. IMPROVED COORDINATION AND PROTECTION 
FOR DUAL ELIGIBLES. 
Title XI of the Social Security Act is amended by 
inserting after section 1150 the following new section: 
‘‘IMPROVED COORDINATION AND PROTECTION FOR DUAL 
ELIGIBLES 
‘‘SEC. 1150A. (a) IN GENERAL.—The Secretary shall 
provide, through an identifiable office or program within 
the Centers for Medicare & Medicaid Services, for a fo-
cused effort to provide for improved coordination between 
Medicare and Medicaid and protection in the case of dual 
eligibles (as defined in subsection (e)). The office or pro-
gram shall— 
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1908 
‘‘(1) review Medicare and Medicaid policies re-
lated to enrollment, benefits, service delivery, pay-
ment, and grievance and appeals processes under 
parts A and B of title XVIII, under the Medicare 
Advantage program under part C of such title, and 
under title XIX; 
‘‘(2) identify areas of such policies where better 
coordination and protection could improve care and 
costs; and 
‘‘(3) issue guidance to States regarding improv-
ing such coordination and protection. 
‘‘(b) ELEMENTS.—The improved coordination and 
protection under this section shall include efforts— 
‘‘(1) to simplify access of dual eligibles to bene-
fits and services under Medicare and Medicaid; 
‘‘(2) to improve care continuity for dual eligi-
bles and ensure safe and effective care transitions; 
‘‘(3) to harmonize regulatory conflicts between 
Medicare and Medicaid rules with regard to dual eli-
gibles; and 
‘‘(4) to improve total cost and quality perform-
ance under Medicare and Medicaid for dual eligibles. 
‘‘(c) RESPONSIBILITIES.—In carrying out this sec-
tion, the Secretary shall provide for the following: 
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1909 
‘‘(1) An examination of Medicare and Medicaid 
payment systems to develop strategies to foster more 
integrated and higher quality care. 
‘‘(2) Development of methods to facilitate ac-
cess to post-acute and community-based services and 
to identify actions that could lead to better coordina-
tion of community-based care. 
‘‘(3) A study of enrollment of dual eligibles in 
the Medicare Savings Program (as defined in section 
1144(c)(7)), under Medicaid, and in the low-income 
subsidy program under section 1860D–14 to identify 
methods to more efficiently and effectively reach and 
enroll dual eligibles. 
‘‘(4) An assessment of communication strate-
gies for dual eligibles to determine whether addi-
tional informational materials or outreach is needed, 
including an assessment of the Medicare website, 1– 
800–MEDICARE, and the Medicare handbook. 
‘‘(5) Research and evaluation of areas where 
service utilization, quality, and access to cost sharing 
protection could be improved and an assessment of 
factors related to enrollee satisfaction with services 
and care delivery. 
‘‘(6) Collection (and making available to the 
public) of data and a database that describe the eli-
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1910 
gibility, benefit and cost-sharing assistance available 
to dual eligibles by State. 
‘‘(7) Monitoring total combined Medicare and 
Medicaid program costs in serving dual eligibles and 
making recommendations for optimizing total quality 
and cost performance across both programs. 
‘‘(8) Coordination of activities relating to Medi-
care Advantage plans under 1859(b)(6)(B)(ii) and 
Medicaid. 
‘‘(d) PERIODIC REPORTS.—Not later than 1 year 
after the date of the enactment of this section and every 
3 years thereafter the Secretary shall submit to Congress 
a report on progress in activities conducted under this sec-
tion. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) DUAL ELIGIBLE.—The term ‘dual eligible’ 
means an individual who is dually eligible for bene-
fits under title XVIII, and medical assistance under 
title XIX, including such individuals who are eligible 
for benefits under the Medicare Savings Program 
(as defined in section 1144(c)(7)). 
‘‘(2) MEDICARE; MEDICAID.—The terms ‘Medi-
care’ and ‘Medicaid’ mean the programs under titles 
XVIII and XIX, respectively.’’. 
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1911 
SUBDIVISION 
C—PUBLIC 
HEALTH 
AND 
WORKFORCE 
DEVELOPMENT 
SEC. 2001. TABLE OF CONTENTS; REFERENCES. 
(a) TABLE OF CONTENTS.—The table of contents of 
this subdivision is as follows: 
Sec. 2001. Table of contents; references. 
Sec. 2002. Public Health Investment Fund. 
TITLE I—COMMUNITY HEALTH CENTERS 
Sec. 2101. Increased funding. 
TITLE II—WORKFORCE 
Subtitle A—Primary Care Workforce 
PART 1—NATIONAL HEALTH SERVICE CORPS 
Sec. 2201. National Health Service Corps. 
Sec. 2202. Authorizations of appropriations. 
PART 2—PROMOTION OF PRIMARY CARE AND DENTISTRY 
Sec. 2211. Frontline health providers. 
Sec. 2212. Primary care student loan funds. 
Sec. 2213. Training in family medicine, general internal medicine, general pedi-
atrics, geriatrics, and physician assistantship. 
Sec. 2214. Training of medical residents in community-based settings. 
Sec. 2215. Training for general, pediatric, and public health dentists and dental 
hygienists. 
Sec. 2216. Authorization of appropriations. 
Subtitle B—Nursing Workforce 
Sec. 2221. Amendments to Public Health Service Act. 
Subtitle C—Public Health Workforce 
Sec. 2231. Public Health Workforce Corps. 
Sec. 2232. Enhancing the public health workforce. 
Sec. 2233. Public health training centers. 
Sec. 2234. Preventive medicine and public health training grant program. 
Sec. 2235. Authorization of appropriations. 
Subtitle D—Adapting Workforce to Evolving Health System Needs 
PART 1—HEALTH PROFESSIONS TRAINING FOR DIVERSITY 
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1912 
Sec. 2241. Scholarships for disadvantaged students, loan repayments and fel-
lowships regarding faculty positions, and educational assistance 
in the health professions regarding individuals from disadvan-
taged backgrounds. 
Sec. 2242. Nursing workforce diversity grants. 
Sec. 2243. Coordination of diversity and cultural competency programs. 
PART 2—INTERDISCIPLINARY TRAINING PROGRAMS 
Sec. 2251. Cultural and linguistic competency training for health care profes-
sionals. 
Sec. 2252. Innovations in interdisciplinary care training. 
PART 3—ADVISORY COMMITTEE ON HEALTH WORKFORCE EVALUATION AND 
ASSESSMENT 
Sec. 2261. Health workforce evaluation and assessment. 
PART 4—HEALTH WORKFORCE ASSESSMENT 
Sec. 2271. Health workforce assessment. 
PART 5—AUTHORIZATION OF APPROPRIATIONS 
Sec. 2281. Authorization of appropriations. 
TITLE III—PREVENTION AND WELLNESS 
Sec. 2301. Prevention and wellness. 
TITLE IV—QUALITY AND SURVEILLANCE 
Sec. 2401. Implementation of best practices in the delivery of health care. 
Sec. 2402. Assistant Secretary for Health Information. 
Sec. 2403. Authorization of appropriations. 
TITLE V—OTHER PROVISIONS 
Subtitle A—Drug Discount for Rural and Other Hospitals 
Sec. 2501. Expanded participation in 340B program. 
Sec. 2502. Extension of discounts to inpatient drugs. 
Sec. 2503. Effective date. 
Subtitle B—School-Based Health Clinics 
Sec. 2511. School-based health clinics. 
Subtitle C—National Medical Device Registry 
Sec. 2521. National medical device registry. 
Subtitle D—Grants for Comprehensive Programs to Provide Education to 
Nurses and Create a Pipeline to Nursing 
Sec. 2531. Establishment of grant program. 
Subtitle E—States Failing To Adhere to Certain Employment Obligations 
Sec. 2541. Limitation on Federal funds. 
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1913 
Subtitle F—Standards for Accessibility to Medical Equipment for Individuals 
With Disabilities. 
Sec. 2541. Access for individuals with disabilities. 
Subtitle G—Other Grant Programs 
Sec. 2551. Reducing student-to-school nurse ratios. 
Sec. 2552. Wellness program grants. 
Sec. 2553. Health professions training for diversity programs. 
Subtitle H—Long-term Care and Family Caregiver Support 
Sec. 2561. Long-term care and family caregiver support. 
Subtitle I—Online Resources 
Sec. 2571. Web site on health care labor market and related educational and 
training opportunities. 
Sec. 2572. Online health workforce training programs. 
(b) REFERENCES.—Except as otherwise specified, 
whenever in this subdivision an amendment is expressed 
in terms of an amendment to a section or other provision, 
the reference shall be considered to be made to a section 
or other provision of the Public Health Service Act (42 
U.S.C. 201 et seq.). 
SEC. 2002. PUBLIC HEALTH INVESTMENT FUND. 
(a) ESTABLISHMENT OF FUNDS.— 
(1) IN GENERAL.—There is established a fund 
to be known as the ‘‘Public Health Investment 
Fund’’ (referred to in this section as the ‘‘Fund’’). 
(2) FUNDING.— 
(A) There shall be deposited into the 
Fund— 
(i) 
for 
fiscal 
year 
2010, 
$4,600,000,000; 
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1914 
(ii) 
for 
fiscal 
year 
2011, 
$5,600,000,000; 
(iii) 
for 
fiscal 
year 
2012, 
$6,900,000,000; 
(iv) 
for 
fiscal 
year 
2013, 
$7,800,000,000; 
(v) 
for 
fiscal 
year 
2014, 
$9,000,000,000; 
(vi) 
for 
fiscal 
year 
2015, 
$9,400,000,000; 
(vii) 
for 
fiscal 
year 
2016, 
$10,100,000,000; 
(viii) 
for 
fiscal 
year 
2017, 
$10,800,000,000; 
(ix) 
for 
fiscal 
year 
2018, 
$11,800,000,000; and 
(x) 
for 
fiscal 
year 
2019, 
$12,700,000,000. 
(B) Amounts deposited into the Fund shall 
be derived from general revenues of the Treas-
ury. 
(b) AUTHORIZATION OF APPROPRIATIONS FROM THE 
FUND.— 
(1) NEW FUNDING.— 
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1915 
(A) IN GENERAL.—Amounts in the Fund 
are authorized to be appropriated by the Com-
mittees on Appropriations of the House of Rep-
resentatives and the Senate for carrying out ac-
tivities under designated public health provi-
sions. 
(B) DESIGNATED PROVISIONS.—For pur-
poses of this paragraph, the term ‘‘designated 
public health provisions’’ means the provisions 
for which amounts are authorized to be appro-
priated under section 330(s), 338(c), 338H–1, 
799C, 872, or 3111 of the Public Health Serv-
ice Act, as added by this subdivision. 
(2) BASELINE FUNDING.— 
(A) IN GENERAL.—Amounts in the Fund 
are authorized to be appropriated (as described 
in paragraph (1)) for a fiscal year only if (ex-
cluding any amounts in or appropriated from 
the Fund)— 
(i) the amounts specified in subpara-
graph (B) for the fiscal year involved are 
equal to or greater than the amounts spec-
ified in subparagraph (B) for fiscal year 
2008; and 
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1916 
(ii) the amounts appropriated, out of 
the general fund of the Treasury, to the 
Prevention and Wellness Trust under sec-
tion 3111 of the Public Health Service 
Act, as added by this subdivision, for the 
fiscal year involved are equal to or greater 
than the funds— 
(I) appropriated under the head-
ing ‘‘Prevention and Wellness Fund’’ 
in title VIII of division A of the Amer-
ican Recovery and Reinvestment Act 
of 2009 (Public Law 111–5); and 
(II) allocated by the second pro-
viso under such heading for evidence- 
based clinical and community-based 
prevention and wellness strategies. 
(B) AMOUNTS SPECIFIED.—The amounts 
specified in this subparagraph, with respect to 
a fiscal year, are the amounts appropriated for 
the following: 
(i) Community health centers (includ-
ing funds appropriated under the authority 
of section 330 of the Public Health Service 
Act (42 U.S.C. 254b)). 
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1917 
(ii) The National Health Service 
Corps Program (including funds appro-
priated under the authority of section 338 
of such Act (42 U.S.C. 254k)). 
(iii) The National Health Service 
Corps Scholarship and Loan Repayment 
Programs (including funds appropriated 
under the authority of section 338H of 
such Act (42 U.S.C. 254q)). 
(iv) Primary care loan funds (includ-
ing funds appropriated for schools of medi-
cine or osteopathic medicine under the au-
thority of section 735(f) of such Act (42 
U.S.C. 292y(f))). 
(v) Primary care education programs 
(including funds appropriated under the 
authority of sections 736, 740, 741, and 
747 of such Act (42 U.S.C. 293, 293d, 
and 293k)). 
(vi) Sections 761 and 770 of such Act 
(42 U.S.C. 294n and 295e). 
(vii) Nursing workforce development 
(including funds appropriated under the 
authority of title VIII of such Act (42 
U.S.C. 296 et seq.)). 
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1918 
(viii) The National Center for Health 
Statistics (including funds appropriated 
under the authority of sections 304, 306, 
307, and 308 of such Act (42 U.S.C. 
242b, 242k, 242l, and 242m)). 
(ix) The Agency for Healthcare Re-
search and Quality (including funds appro-
priated under the authority of title IX of 
such Act (42 U.S.C. 299 et seq.)). 
(3) BUDGETARY IMPLICATIONS.—Amounts ap-
propriated under this section, and outlays flowing 
from such appropriations, shall not be taken into ac-
count for purposes of any budget enforcement proce-
dures including allocations under section 302(a) and 
(b) of the Balanced Budget and Emergency Deficit 
Control Act and budget resolutions for fiscal years 
during which appropriations are made from the 
Fund. 
TITLE I—COMMUNITY HEALTH 
CENTERS 
SEC. 2101. INCREASED FUNDING. 
Section 330 of the Public Health Service Act (42 
U.S.C. 254b) is amended— 
(1) in subsection (r)(1)— 
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1919 
(A) in subparagraph (D), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (E), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by inserting at the end the following: 
‘‘(F) Such sums as may be necessary for 
each of fiscal years 2013 and 2019.’’; and 
(2) by inserting after subsection (r) the fol-
lowing: 
‘‘(s) ADDITIONAL FUNDING.—For the purpose of 
carrying out this section, in addition to any other amounts 
authorized to be appropriated for such purpose, there are 
authorized to be appropriated, out of any monies in the 
Public Health Investment Fund, the following: 
‘‘(1) For fiscal year 2010, $1,000,000,000. 
‘‘(2) For fiscal year 2011, $1,500,000,000. 
‘‘(3) For fiscal year 2012, $2,500,000,000. 
‘‘(4) For fiscal year 2013, $3,000,000,000. 
‘‘(5) For fiscal year 2014, $4,000,000,000. 
‘‘(6) For fiscal year 2015, $4,400,000,000. 
‘‘(7) For fiscal year 2016, $4,800,000,000. 
‘‘(8) For fiscal year 2017, $5,300,000,000. 
‘‘(9) For fiscal year 2018, $5,900,000,000. 
‘‘(10) For fiscal year 2019, $6,400,000,000.’’. 
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1920 
TITLE II—WORKFORCE 
Subtitle A—Primary Care 
Workforce 
PART 1—NATIONAL HEALTH SERVICE CORPS 
SEC. 2201. NATIONAL HEALTH SERVICE CORPS. 
(a) FULFILLMENT
OF OBLIGATED SERVICE RE-
QUIREMENT THROUGH HALF-TIME SERVICE.— 
(1) WAIVERS.—Subsection (i) of section 331 
(42 U.S.C. 254d) is amended— 
(A) in paragraph (1), by striking ‘‘In car-
rying out subpart III’’ and all that follows 
through the period and inserting ‘‘In carrying 
out subpart III, the Secretary may, in accord-
ance with this subsection, issue waivers to indi-
viduals who have entered into a contract for ob-
ligated service under the Scholarship Program 
or the Loan Repayment Program under which 
the individuals are authorized to satisfy the re-
quirement of obligated service through pro-
viding clinical practice that is half-time.’’; 
(B) in paragraph (2)— 
(i) in subparagraphs (A)(ii) and (B), 
by striking ‘‘less than full time’’ each place 
it appears and inserting ‘‘half time’’; 
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1921 
(ii) in subparagraphs (C) and (F), by 
striking ‘‘less than full-time service’’ each 
place it appears and inserting ‘‘half-time 
service’’; and 
(iii) by amending subparagraphs (D) 
and (E) to read as follows: 
‘‘(D) the entity and the Corps member agree in 
writing that the Corps member will perform half- 
time clinical practice; 
‘‘(E) the Corps member agrees in writing to 
fulfill all of the service obligations under section 
338C through half-time clinical practice and ei-
ther— 
‘‘(i) double the period of obligated service; 
or 
‘‘(ii) in the case of contracts entered into 
under section 338B, accept a minimum service 
obligation of 2 years with an award amount 
equal to 50 percent of the amount that would 
otherwise be payable for full-time service; and’’; 
and 
(C) in paragraph (3), by striking ‘‘In eval-
uating a demonstration project described in 
paragraph (1)’’ and inserting ‘‘In evaluating 
waivers issued under paragraph (1)’’. 
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1922 
(2) DEFINITIONS.—Subsection (j) of section 
331 (42 U.S.C. 254d) is amended by adding at the 
end the following: 
‘‘(5) The terms ‘full time’ and ‘full-time’ mean 
a minimum of 40 hours per week in a clinical prac-
tice, for a minimum of 45 weeks per year. 
‘‘(6) The terms ‘half time’ and ‘half-time’ mean 
a minimum of 20 hours per week (not to exceed 39 
hours per week) in a clinical practice, for a min-
imum of 45 weeks per year.’’. 
(b) REAPPOINTMENT TO NATIONAL ADVISORY COUN-
CIL.—Section 337(b)(1) (42 U.S.C. 254j(b)(1)) is amend-
ed by striking ‘‘Members may not be reappointed to the 
Council.’’. 
(c) 
LOAN
REPAYMENT
AMOUNT.—Section 
338B(g)(2)(A) is amended (42 U.S.C. 254l–1(g)(2)(A)) 
by striking ‘‘$35,000’’ and inserting ‘‘$50,000, plus, be-
ginning with fiscal year 2012, an amount determined by 
the Secretary on an annual basis to reflect inflation,’’. 
(d) TREATMENT OF TEACHING AS OBLIGATED SERV-
ICE.—Subsection (a) of section 338C (42 U.S.C. 254m) 
is amended by adding at the end the following: ‘‘The Sec-
retary may treat teaching as clinical practice for up to 
20 percent of such period of obligated service.’’. 
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1923 
SEC. 2202. AUTHORIZATIONS OF APPROPRIATIONS. 
(a) NATIONAL
HEALTH
SERVICE
CORPS
PRO-
GRAM.—Section 338 (42 U.S.C. 254k) is amended— 
(1) in subsection (a), by striking ‘‘2012’’ and 
inserting ‘‘2019’’; and 
(2) by adding at the end the following: 
‘‘(c) For the purpose of carrying out this subpart, 
in addition to any other amounts authorized to be appro-
priated for such purpose, there are authorized to be appro-
priated, out of any monies in the Public Health Invest-
ment Fund, the following: 
‘‘(1) $63,000,000 for fiscal year 2010. 
‘‘(2) $66,000,000 for fiscal year 2011. 
‘‘(3) $70,000,000 for fiscal year 2012. 
‘‘(4) $73,000,000 for fiscal year 2013. 
‘‘(5) $77,000,000 for fiscal year 2014. 
‘‘(6) $81,000,000 for fiscal year 2015. 
‘‘(7) $85,000,000 for fiscal year 2016. 
‘‘(8) $89,000,000 for fiscal year 2017. 
‘‘(9) $94,000,000 for fiscal year 2018. 
‘‘(10) $98,000,000 for fiscal year 2019.’’. 
(b) SCHOLARSHIP
AND LOAN REPAYMENT PRO-
GRAMS.—Subpart III of part D of title III of the Public 
Health Service Act (42 U.S.C. 254l et seq.) is amended— 
(1) in section 338H(a)— 
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1924 
(A) in paragraph (4), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (5), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(6) for fiscal years 2013 and 2019, such sums 
as may be necessary.’’; and 
(2) by inserting after section 338H the fol-
lowing: 
‘‘SEC. 338H–1. ADDITIONAL FUNDING. 
‘‘For the purpose of carrying out this subpart, in ad-
dition to any other amounts authorized to be appropriated 
for such purpose, there are authorized to be appropriated, 
out of any monies in the Public Health Investment Fund, 
the following: 
‘‘(1) $254,000,000 for fiscal year 2010. 
‘‘(2) $266,000,000 for fiscal year 2011. 
‘‘(3) $278,000,000 for fiscal year 2012. 
‘‘(4) $292,000,000 for fiscal year 2013. 
‘‘(5) $306,000,000 for fiscal year 2014. 
‘‘(6) $321,000,000 for fiscal year 2015. 
‘‘(7) $337,000,000 for fiscal year 2016. 
‘‘(8) $354,000,000 for fiscal year 2017. 
‘‘(9) $372,000,000 for fiscal year 2018. 
‘‘(10) $391,000,000 for fiscal year 2019.’’. 
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1925 
PART 2—PROMOTION OF PRIMARY CARE AND 
DENTISTRY 
SEC. 2211. FRONTLINE HEALTH PROVIDERS. 
Part D of title III (42 U.S.C. 254b et seq.) is amend-
ed by adding at the end the following: 
‘‘Subpart XI—Health Professional Needs Areas 
‘‘SEC. 340H. IN GENERAL. 
‘‘(a) PROGRAM.—The Secretary, acting through the 
Administrator of the Health Resources and Services Ad-
ministration, shall establish a program, to be known as 
the Frontline Health Providers Loan Repayment Pro-
gram, to address unmet health care needs in health profes-
sional needs areas through loan repayments under section 
340I. 
‘‘(b) DESIGNATION
OF
HEALTH
PROFESSIONAL 
NEEDS AREAS.— 
‘‘(1) IN GENERAL.—In this subpart, the term 
‘health professional needs area’ means an area, pop-
ulation, or facility that is designated by the Sec-
retary in accordance with paragraph (2). 
‘‘(2) DESIGNATION.—To be designated by the 
Secretary as a health professional needs area under 
this subpart: 
‘‘(A) In the case of an area, the area must 
be a rational area for the delivery of health 
services. 
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1926 
‘‘(B) The area, population, or facility must 
have, in one or more health disciplines, special-
ties, or subspecialties for the population served, 
as determined by the Secretary— 
‘‘(i) insufficient capacity of health 
professionals; or 
‘‘(ii) high needs for health services. 
‘‘(C) With respect to the delivery of pri-
mary health services, the area, population, or 
facility must not include a health professional 
shortage area (as designated under section 
332), except that the area, population, or facil-
ity may include such a health professional 
shortage area to which no member of the Na-
tional Health Service Corps is currently as-
signed. 
‘‘(c) ELIGIBILITY.—To be eligible to participate in 
the Program, an individual shall— 
‘‘(1) hold a degree in a course of study or pro-
gram (approved by the Secretary) from a school de-
fined in section 799B(1)(A) (other than a school of 
public health); 
‘‘(2) hold a degree in a course of study or pro-
gram (approved by the Secretary) from a school or 
program defined in subparagraph (C), (D), or 
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1927 
(E)(4) of section 799B(1), as designated by the Sec-
retary; 
‘‘(3) be enrolled as a full-time student— 
‘‘(A) in a school or program defined in 
subparagraph (C), (D), or (E)(4) of section 
799B(1), as designated by the Secretary, or a 
school described in paragraph (1); and 
‘‘(B) in the final year of a course of study 
or program, offered by such school or program 
and approved by the Secretary, leading to a de-
gree in a discipline referred to in subparagraph 
(A) (other than a graduate degree in public 
health), (C), (D), or (E)(4) of section 799B(1); 
‘‘(4) be a practitioner described in section 
1842(b)(18)(C) or 1848(k)(3)(B)(iii) or (iv) of the 
Social Security Act; or 
‘‘(5) be a practitioner in the field of respiratory 
therapy, medical technology, or radiologic tech-
nology. 
‘‘(d) DEFINITION.—In this subpart, the term ‘pri-
mary health services’ has the meaning given to such term 
in section 331(a)(3)(D). 
‘‘SEC. 340I. LOAN REPAYMENTS. 
‘‘(a) LOAN REPAYMENTS.—The Secretary, acting 
through the Administrator of the Health Resources and 
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1928 
Services Administration, shall enter into contracts with in-
dividuals under which— 
‘‘(1) the individual agrees— 
‘‘(A) to serve as a full-time primary health 
services provider or as a full-time or part-time 
provider of other health services for a period of 
time equal to 2 years or such longer period as 
the individual may agree to; 
‘‘(B) to serve in a health professional 
needs area in a health discipline, specialty, or a 
subspecialty for which the area, population, or 
facility is designated as a health professional 
needs area under section 340H; and 
‘‘(C) in the case of an individual described 
in subsection 340H(c)(3) who is in the final 
year of study and who has accepted employ-
ment as primary health services provider or 
provider of other health services in accordance 
with subparagraphs (A) and (B), to complete 
the education or training and maintain an ac-
ceptable level of academic standing (as deter-
mined by the educational institution offering 
the course of study or training); and 
‘‘(2) the Secretary agrees to pay, for each year 
of such service, an amount on the principal and in-
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1929 
terest of the undergraduate or graduate educational 
loans (or both) of the individual that is not more 
than 50 percent of the average award made under 
the National Health Service Corps Loan Repayment 
Program under subpart III in that year. 
‘‘(b) PRACTICE SETTING.—A contract entered into 
under this section shall allow the individual receiving the 
loan repayment to satisfy the service requirement de-
scribed in subsection (a)(1) through employment in a solo 
or group practice, a clinic, an accredited public or private 
nonprofit hospital, or any other health care entity, as 
deemed appropriate by the Secretary. 
‘‘(c) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D shall, except as incon-
sistent with this section, apply to the loan repayment pro-
gram under this subpart in the same manner and to the 
same extent as such provisions apply to the National 
Health Service Corps Loan Repayment Program estab-
lished under section 338B. 
‘‘(d) INSUFFICIENT NUMBER OF APPLICANTS.—If 
there are an insufficient number of applicants for loan re-
payments under this section to obligate all appropriated 
funds, the Secretary shall transfer the unobligated funds 
to the National Health Service Corps for the purpose of— 
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1930 
‘‘(1) recruitment of sufficient applicants for the 
National Health Service Corps for the following 
year; or 
‘‘(2) making additional loan repayments under 
section 338B if there is an excess number of quali-
fied applicants for loan repayments under such sec-
tion. 
‘‘SEC. 340J. REPORT. 
‘‘The Secretary shall submit to the Congress an an-
nual report on the program carried out under this subpart. 
‘‘SEC. 340K. ALLOCATION. 
‘‘Of the amount of funds obligated under this subpart 
each fiscal year for loan repayments— 
‘‘(1) 90 percent shall be for physicians and 
other health professionals providing primary health 
services; and 
‘‘(2) 10 percent shall be for health professionals 
not described in paragraph (1).’’. 
SEC. 2212. PRIMARY CARE STUDENT LOAN FUNDS. 
(a) LOAN PROVISIONS.—Section 722 (42 U.S.C. 
292r) is amended by striking subsection (e) and inserting 
the following: 
‘‘(e) RATE OF INTEREST.—Such loans shall bear in-
terest, on the unpaid balance of the loan, computed only 
for periods for which the loan is repayable, at the rate 
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1931 
of 2 percentage points less than the applicable rate of in-
terest described in section 427A(l)(1) of the Higher Edu-
cation Act of 1965 per year.’’. 
(b) MEDICAL
SCHOOLS
AND
PRIMARY
HEALTH 
CARE.—Subsection (a) of section 723 (42 U.S.C. 292s) 
is amended— 
(1) in paragraph (1), by striking subparagraph 
(B) and inserting the following: 
‘‘(B) to practice in such care for 10 years 
(including residency training in primary health 
care) or through the date on which the loan is 
repaid in full, whichever occurs first.’’; and 
(2) by striking paragraph (3) and inserting the 
following: 
‘‘(3) NONCOMPLIANCE BY STUDENT.—If an in-
dividual fails to comply with an agreement entered 
into pursuant to paragraph (1), such agreement 
shall provide that the total interest to be paid on the 
loan, over the course of the loan period, shall equal 
the total amount of interest that would have been in-
curred by the individual if, from the outset of the 
loan, the loan was repayable at the rate of interest 
described in section 427A(l)(1) of the Higher Edu-
cation Act of 1965 per year instead of the rate of 
interest described in section 722(e).’’. 
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1932 
(c) STUDENT LOAN GUIDELINES.— 
(1) IN
GENERAL.—Section 735 (42 U.S.C. 
292y) is amended— 
(A) by redesignating subsection (f) as sub-
section (g); and 
(B) by inserting after subsection (e) the 
following: 
‘‘(f) DETERMINATION OF FINANCIAL NEED.—The 
Secretary— 
‘‘(1) may require, or authorize a school or other 
entity to require, the submission of financial infor-
mation to determine the financial resources available 
to any individual seeking assistance under this sub-
part; and 
‘‘(2) shall take into account the extent to which 
such individual is financially independent in deter-
mining whether to require or authorize the submis-
sion of such information regarding such individual’s 
family members.’’. 
(2) REVISED GUIDELINES.—The Secretary of 
Health and Human Services shall— 
(A) strike the second sentence of section 
57.206(b) of title 42, Code of Federal Regula-
tions; and 
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1933 
(B) make such other revisions to guidelines 
and regulations in effect as of the date of the 
enactment of this Act as may be necessary for 
consistency with the amendments made by 
paragraph (1). 
SEC. 2213. TRAINING IN FAMILY MEDICINE, GENERAL IN-
TERNAL MEDICINE, GENERAL PEDIATRICS, 
GERIATRICS, 
AND 
PHYSICIAN 
ASSISTANTSHIP. 
Section 747 (42 U.S.C. 293k) is amended— 
(1) by amending the section heading to read as 
follows: ‘‘PRIMARY
CARE
TRAINING
AND
EN-
HANCEMENT’’; 
(2) by redesignating subsection (e) as sub-
section (f); and 
(3) by striking subsections (a) through (d) and 
inserting the following: 
‘‘(a) PROGRAM.—The Secretary shall establish a pri-
mary care training and capacity building program con-
sisting of awarding grants and contracts under sub-
sections (b) and (c). 
‘‘(b) SUPPORT
AND DEVELOPMENT
OF PRIMARY 
CARE TRAINING PROGRAMS.— 
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1935 
ticing physicians who are participants in any 
such programs and who plan to teach in a fam-
ily medicine, general internal medicine, general 
pediatrics, or geriatrics training program; and 
‘‘(E) to plan, develop, operate, or partici-
pate in an accredited program for physician as-
sistant education, and for the training of indi-
viduals who plan to teach in programs to pro-
vide such training. 
‘‘(2) ELIGIBILITY.—To be eligible for a grant 
or contract under paragraph (1), an entity shall 
be— 
‘‘(A) an accredited school of medicine or 
osteopathic medicine, public or nonprofit private 
hospital, or physician assistant training pro-
gram; 
‘‘(B) a public or private nonprofit entity; 
or 
‘‘(C) a consortium of 2 or more entities de-
scribed in subparagraphs (A) and (B). 
‘‘(c) CAPACITY BUILDING IN PRIMARY CARE.— 
‘‘(1) IN GENERAL.—The Secretary shall make 
grants to or enter into contracts with eligible entities 
to establish, maintain, or improve— 
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1936 
‘‘(A) academic administrative units (in-
cluding departments, divisions, or other appro-
priate units) in the specialties of family medi-
cine, general internal medicine, general pediat-
rics, or geriatrics; or 
‘‘(B) programs that improve clinical teach-
ing in such specialties. 
‘‘(2) ELIGIBILITY.—To be eligible for a grant 
or contract under paragraph (1), an entity shall be 
an accredited school of medicine or osteopathic med-
icine. 
‘‘(d) PREFERENCE.—In awarding grants or contracts 
under this section, the Secretary shall give preference to 
entities that have a demonstrated record of the following: 
‘‘(1) Training the greatest percentage, or sig-
nificantly improving the percentage, of health care 
professionals who provide primary care. 
‘‘(2) Training individuals who are from under-
represented minority groups or disadvantaged back-
grounds. 
‘‘(3) A high rate of placing graduates in prac-
tice settings having the principal focus of serving in 
underserved areas or populations experiencing health 
disparities (including serving patients eligible for 
medical assistance under title XIX of the Social Se-
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1937 
curity Act or for child health assistance under title 
XXI of such Act or those with special health care 
needs). 
‘‘(4) Supporting teaching programs that ad-
dress the health care needs of vulnerable popu-
lations. 
‘‘(e) REPORT.—The Secretary shall submit to the 
Congress an annual report on the program carried out 
under this section. 
‘‘(f) DEFINITION.—In this section, the term ‘health 
disparities’ has the meaning given the term in section 
3171.’’. 
SEC. 2214. TRAINING OF MEDICAL RESIDENTS IN COMMU-
NITY-BASED SETTINGS. 
Title VII (42 U.S.C. 292 et seq.) is amended— 
(1) by redesignating section 748 as 749A; and 
(2) by inserting after section 747 the following: 
‘‘SEC. 748. TRAINING OF MEDICAL RESIDENTS IN COMMU-
NITY-BASED SETTINGS. 
‘‘(a) PROGRAM.—The Secretary shall establish a pro-
gram for the training of medical residents in community- 
based settings consisting of awarding grants or contracts 
under this section. 
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1938 
‘‘(b) DEVELOPMENT AND OPERATION OF COMMU-
NITY-BASED
PROGRAMS.—The Secretary shall make 
grants to, or enter into contracts with, eligible entities— 
‘‘(1) to plan and develop a new primary care 
residency training program, which may include— 
‘‘(A) planning and developing curricula; 
‘‘(B) recruiting and training residents and 
faculty; and 
‘‘(C) other activities designated to result in 
accreditation of such a program; or 
‘‘(2) to operate or participate in an established 
primary care residency training program, which may 
include— 
‘‘(A) planning and developing curricula; 
‘‘(B) recruitment and training of residents; 
and 
‘‘(C) retention of faculty. 
‘‘(c) ELIGIBLE ENTITY.—To be eligible to receive a 
grant or contract under subsection (b), an entity shall— 
‘‘(1) be designated as a recipient of payment 
for the direct costs of medical education under sec-
tion 1886(k) of the Social Security Act; 
‘‘(2) be designated as an approved teaching 
health center under section 1502(d) of the America’s 
Affordable Health Choices Act of 2009 and con-
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1939 
tinuing to participate in the demonstration project 
under such section; or 
‘‘(3) be an applicant for designation described 
in paragraph (1) or (2) and have demonstrated to 
the Secretary appropriate involvement of an accred-
ited teaching hospital to carry out the inpatient re-
sponsibilities associated with a primary care resi-
dency training program. 
‘‘(d) PREFERENCES.—In awarding grants and con-
tracts under paragraph (1) or (2) of subsection (b), the 
Secretary shall give preference to entities that— 
‘‘(1) support teaching programs that address 
the health care needs of vulnerable populations; or 
‘‘(2) are a Federally qualified health center (as 
defined in section 1861(aa)(4) of the Social Security 
Act) or a rural health clinic (as defined in section 
1861(aa)(2) of such Act). 
‘‘(e) ADDITIONAL PREFERENCES FOR ESTABLISHED 
PROGRAMS.—In awarding grants and contracts under 
subsection (b)(2), the Secretary shall give preference to 
entities that have a demonstrated record of training— 
‘‘(1) a high or significantly improved percentage 
of health care professionals who provide primary 
care; 
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1940 
‘‘(2) individuals who are from underrepresented 
minority groups or disadvantaged backgrounds; or 
‘‘(3) individuals who practice in settings having 
the principal focus of serving underserved areas or 
populations experiencing health disparities (including 
serving patients eligible for medical assistance under 
title XIX of the Social Security Act or for child 
health assistance under title XXI of such Act or 
those with special health care needs). 
‘‘(f) PERIOD OF AWARDS.— 
‘‘(1) IN GENERAL.—The period of a grant or 
contract under this section— 
‘‘(A) shall not exceed 2 years for awards 
under subsection (b)(1); and 
‘‘(B) shall not exceed 5 years for awards 
under subsection (b)(2). 
‘‘(2) SPECIAL RULES.— 
‘‘(A) An award of a grant or contract 
under subsection (b)(1) shall not be renewed. 
‘‘(B) The period of a grant or contract 
awarded to an entity under subsection (b)(2) 
shall not overlap with the period of any grant 
or contact awarded to the same entity under 
subsection (b)(1). 
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1941 
‘‘(g) REPORT.—The Secretary shall submit to the 
Congress an annual report on the program carried out 
under this section. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) PRIMARY CARE RESIDENCY TRAINING PRO-
GRAM.—The term ‘primary care residency training 
program’ means an approved medical residency 
training program described in section 1886(h)(5)(A) 
of the Social Security Act that is— 
‘‘(A) in the case of entities seeking awards 
under subsection (b)(1), actively applying to be 
accredited by the Accreditation Council for 
Graduate Medical Education; or 
‘‘(B) in the case of entities seeking awards 
under subsection (b)(2), so accredited. 
‘‘(2) HEALTH DISPARITIES.—The term ‘health 
disparities’ has the meaning given the term in sec-
tion 3171.’’. 
SEC. 2215. TRAINING FOR GENERAL, PEDIATRIC, AND PUB-
LIC HEALTH DENTISTS AND DENTAL HYGIEN-
ISTS. 
Title VII (42 U.S.C. 292 et seq.) is amended— 
(1) in section 791(a)(1), by striking ‘‘747 and 
750’’ and inserting ‘‘747, 749, and 750’’; and 
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1942 
(2) by inserting after section 748, as added, the 
following: 
‘‘SEC. 749. TRAINING FOR GENERAL, PEDIATRIC, AND PUB-
LIC HEALTH DENTISTS AND DENTAL HYGIEN-
ISTS. 
‘‘(a) PROGRAM.—The Secretary shall establish a den-
tal medicine training program consisting of awarding 
grants and contracts under this section. 
‘‘(b) SUPPORT
AND DEVELOPMENT
OF DENTAL 
TRAINING PROGRAMS.—The Secretary shall make grants 
to, or enter into contracts with, eligible entities— 
‘‘(1) to plan, develop, operate, or participate in 
an accredited professional training program for oral 
health professionals; 
‘‘(2) to provide financial assistance to oral 
health professionals who are in need thereof, who 
are participants in any such program, and who plan 
to work in general, pediatric, or public heath den-
tistry, or dental hygiene; 
‘‘(3) to plan, develop, operate, or participate in 
a program for the training of oral health profes-
sionals who plan to teach in general, pediatric, or 
public health dentistry, or dental hygiene; 
‘‘(4) to provide financial assistance in the form 
of traineeships and fellowships to oral health profes-
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1943 
sionals who plan to teach in general, pediatric, or 
public health dentistry or dental hygiene; 
‘‘(5) to establish, maintain, or improve— 
‘‘(A) academic administrative units (in-
cluding departments, divisions, or other appro-
priate units) in the specialties of general, pedi-
atric, or public health dentistry; or 
‘‘(B) programs that improve clinical teach-
ing in such specialties; 
‘‘(6) to plan, develop, operate, or participate in 
predoctoral and postdoctoral training in general, pe-
diatric, or public health dentistry programs, or train-
ing for dental hygienists; 
‘‘(7) to plan, develop, operate, or participate in 
a loan repayment program for full-time faculty in a 
program of general, pediatric, or public health den-
tistry; and 
‘‘(8) to provide technical assistance to pediatric 
dental training programs in developing and imple-
menting instruction regarding the oral health status, 
dental care needs, and risk-based clinical disease 
management of all pediatric populations with an em-
phasis on underserved children. 
‘‘(c) ELIGIBILITY.—To be eligible for a grant or con-
tract under subsection (a), an entity shall be— 
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1944 
‘‘(1) an accredited school of dentistry, training 
program in dental hygiene, or public or nonprofit 
private hospital; 
‘‘(2) a training program in dental hygiene at an 
accredited institution of higher education; 
‘‘(3) a public or private nonprofit entity; or 
‘‘(4) a consortium of— 
‘‘(A) 2 or more of the entities described in 
paragraphs (1) through (3); and 
‘‘(B) an accredited school of public health. 
‘‘(d) PREFERENCE.—In awarding grants or contracts 
under this section, the Secretary shall give preference to 
entities that have a demonstrated record of the following: 
‘‘(1) Training the greatest percentage, or sig-
nificantly improving the percentage, of oral health 
professionals who practice general, pediatric, or pub-
lic health dentistry. 
‘‘(2) Training individuals who are from under-
represented minority groups or disadvantaged back-
grounds. 
‘‘(3) A high rate of placing graduates in prac-
tice settings having the principal focus of serving in 
underserved areas or populations experiencing health 
disparities (including serving patients eligible for 
medical assistance under title XIX of the Social Se-
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1945 
curity Act or for child health assistance under title 
XXI of such Act or those with special health care 
needs). 
‘‘(4) Supporting teaching programs that ad-
dress the dental needs of vulnerable populations. 
‘‘(5) Providing instruction regarding the oral 
health status, dental care needs, and risk-based clin-
ical disease management of all pediatric populations 
with an emphasis on underserved children. 
‘‘(e) REPORT.—The Secretary shall submit to the 
Congress an annual report on the program carried out 
under this section. 
‘‘(f) DEFINITION.—In this section: 
‘‘(1) The term ‘health disparities’ has the 
meaning given the term in section 3171. 
‘‘(2) The term ‘oral health professional’ means 
an individual training or practicing— 
‘‘(A) in general dentistry, pediatric den-
tistry, public health dentistry, or dental hy-
giene; or 
‘‘(B) another dental medicine specialty, as 
deemed appropriate by the Secretary.’’. 
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1946 
SEC. 2216. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—Part F of title VII (42 U.S.C. 
295j et seq.) is amended by adding at the end the fol-
lowing: 
‘‘SEC. 799C. FUNDING THROUGH PUBLIC HEALTH INVEST-
MENT FUND. 
‘‘(a) PROMOTION
OF PRIMARY CARE
AND DEN-
TISTRY.—For the purpose of carrying out subpart XI of 
part D of title III and sections 723, 747, 748, and 749, 
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, the following: 
‘‘(1) $240,000,000 for fiscal year 2010. 
‘‘(2) $253,000,000 for fiscal year 2011. 
‘‘(3) $265,000,000 for fiscal year 2012. 
‘‘(4) $278,000,000 for fiscal year 2013. 
‘‘(5) $292,000,000 for fiscal year 2014. 
‘‘(6) $307,000,000 for fiscal year 2015. 
‘‘(7) $322,000,000 for fiscal year 2016. 
‘‘(8) $338,000,000 for fiscal year 2017. 
‘‘(9) $355,000,000 for fiscal year 2018. 
‘‘(10) $373,000,000 for fiscal year 2019.’’. 
(b) EXISTING
AUTHORIZATIONS
OF
APPROPRIA-
TIONS.— 
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1947 
(1) SECTION
735.—Paragraph (1) of section 
735(g), as so redesignated, is amended by inserting 
‘‘and such sums as may be necessary for subsequent 
years through fiscal year 2019’’ before the period at 
the end. 
(2) SECTION 747.—Subsection (f), as so redes-
ignated, of section 747 (42 U.S.C. 293k) is amended 
by striking ‘‘2002’’ and inserting ‘‘2019’’. 
Subtitle B—Nursing Workforce 
SEC. 2221. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT. 
(a) DEFINITIONS.—Section 801 (42 U.S.C. 296 et 
seq.) is amended— 
(1) in paragraph (1), by inserting ‘‘nurse-man-
aged health centers’’ after ‘‘nursing centers,’’; and 
(2) by adding at the end the following: 
‘‘(16) NURSE-MANAGED
HEALTH
CENTER.— 
The term ‘nurse-managed health center’ means a 
nurse-practice arrangement, managed by advanced 
practice nurses, that provides primary care or 
wellness services to underserved or vulnerable popu-
lations and is associated with an accredited school of 
nursing, Federally qualified health center, or inde-
pendent nonprofit health or social services agency.’’. 
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1948 
(a) GRANTS
FOR
HEALTH
PROFESSIONS
EDU-
CATION.—Title VIII (42 U.S.C. 296 et seq.) is amended 
by striking section 807. 
(b) ADVANCED EDUCATION NURSING GRANTS.—Sec-
tion 811(f) (42 U.S.C. 296j(f)) is amended— 
(1) by striking paragraph (2); 
(2) by redesignating paragraph (3) as para-
graph (2); and 
(3) in paragraph (2), as so redesignated, by 
striking ‘‘that agrees’’ and all that follows through 
the end and inserting: ‘‘that agrees to expend the 
award— 
‘‘(A) to train advanced education nurses 
who will practice in health professional shortage 
areas designated under section 332; or 
‘‘(B) to increase diversity among advanced 
education nurses.’’. 
(c) NURSE EDUCATION, PRACTICE, AND RETENTION 
GRANTS.—Section 831 (42 U.S.C. 296p) is amended— 
(1) in subsection (b), by amending paragraph 
(3) to read as follows: 
‘‘(3) providing coordinated care, quality care, 
and other skills needed to practice nursing;’’; and 
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1949 
(2) by striking subsection (e) and redesignating 
subsections (f) through (h) as subsections (e) 
through (g), respectively. 
(d) STUDENT LOANS.—Subsection (a) of section 836 
(42 U.S.C. 297b) is amended— 
(1) 
by 
striking 
‘‘$2,500’’ 
and 
inserting 
‘‘$3,300’’; 
(2) 
by 
striking 
‘‘$4,000’’ 
and 
inserting 
‘‘$5,200’’; 
(3) by striking ‘‘$13,000’’ and inserting 
‘‘$17,000’’; and 
(4) by adding at the end the following: ‘‘Begin-
ning with fiscal year 2012, the dollar amounts speci-
fied in this subsection shall be adjusted by an 
amount determined by the Secretary on an annual 
basis to reflect inflation.’’. 
(e) LOAN REPAYMENT.—Section 846 (42 U.S.C. 
297n) is amended— 
(1) in subsection (a), by amending paragraph 
(3) to read as follows: 
‘‘(3) who enters into an agreement with the 
Secretary to serve for a period of not less than 2 
years— 
‘‘(A) as a nurse at a health care facility 
with a critical shortage of nurses; or 
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‘‘(B) as a faculty member at an accredited 
school of nursing;’’; and 
(2) in subsection (g)(1), by striking ‘‘to provide 
health services’’ each place it appears and inserting 
‘‘to provide health services or serve as a faculty 
member’’. 
(f) NURSE FACULTY LOAN PROGRAM.—Paragraph 
(2) of section 846A(c) (42 U.S.C. 297n–1(c)) is amended 
by striking ‘‘$30,000’’ and all that follows through the 
semicolon and inserting ‘‘$35,000, plus, beginning with 
fiscal year 2012, an amount determined by the Secretary 
on an annual basis to reflect inflation;’’. 
(g) PUBLIC SERVICE ANNOUNCEMENTS.—Title VIII 
(42 U.S.C. 296 et seq.) is amended by striking part H. 
(h) TECHNICAL AND CONFORMING AMENDMENTS.— 
Title VIII (42 U.S.C. 296 et seq.) is amended— 
(1) by redesignating section 810 (relating to 
prohibition against discrimination by schools on the 
basis of sex) as section 809 and moving such section 
so that it follows section 808; 
(2) in sections 835, 836, 838, 840, and 842, by 
striking the term ‘‘this subpart’’ each place it ap-
pears and inserting ‘‘this part’’; 
(3) in section 836(h), by striking the last sen-
tence; 
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1951 
(4) in section 836, by redesignating subsection 
(l) as subsection (k); 
(5) in section 839, by striking ‘‘839’’ and all 
that follows through ‘‘(a)’’ and inserting ‘‘839. (a)’’; 
(6) in section 835(b), by striking ‘‘841’’ each 
place it appears and inserting ‘‘871’’; 
(7) by redesignating section 841 as section 871, 
moving part F to the end of the title, and redesig-
nating such part as part H; 
(8) in part G— 
(A) by redesignating section 845 as section 
851; and 
(B) by redesignating part G as part F; and 
(9) in part I— 
(A) by redesignating section 855 as section 
861; and 
(B) by redesignating part I as part G. 
(i) FUNDING.— 
(1) IN GENERAL.—Part H, as redesignated, of 
title VIII is amended by adding at the end the fol-
lowing: 
‘‘SEC. 872. FUNDING THROUGH PUBLIC HEALTH INVEST-
MENT FUND. 
‘‘For the purpose of carrying out this title, in addi-
tion to any other amounts authorized to be appropriated 
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1952 
for such purpose, there are authorized to be appropriated, 
out of any monies in the Public Health Investment Fund, 
the following: 
‘‘(1) $115,000,000 for fiscal year 2010. 
‘‘(2) $122,000,000 for fiscal year 2011. 
‘‘(3) $127,000,000 for fiscal year 2012. 
‘‘(4) $134,000,000 for fiscal year 2013. 
‘‘(5) $140,000,000 for fiscal year 2014. 
‘‘(6) $147,000,000 for fiscal year 2015. 
‘‘(7) $154,000,000 for fiscal year 2016. 
‘‘(8) $162,000,000 for fiscal year 2017. 
‘‘(9) $170,000,000 for fiscal year 2018. 
‘‘(10) $179,000,000 for fiscal year 2019.’’. 
(2) EXISTING AUTHORIZATIONS OF APPROPRIA-
TIONS.— 
(A) SECTIONS 831, 846, 846A, AND 861.— 
Sections 831(g) (as so redesignated), 846(i)(1) 
(42 U.S.C. 297n(i)(1)), 846A(f) (42 U.S.C. 
297n–1(f)), and 861(e) (as so redesignated) are 
amended by striking ‘‘2007’’ each place it ap-
pears and inserting ‘‘2019’’. 
(B) SECTION 871.—Section 871, as so re-
designated, is amended to read as follows: 
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1953 
‘‘SEC. 871. FUNDING. 
‘‘For the purpose of carrying out parts B, C, and D 
(subject to section 845(g)), there are authorized to be ap-
propriated such sums as may be necessary for each fiscal 
year through fiscal year 2019.’’. 
Subtitle C—Public Health 
Workforce 
SEC. 2231. PUBLIC HEALTH WORKFORCE CORPS. 
Part D of title III (42 U.S.C. 254b et seq.), as 
amended by section 2211, is amended by adding at the 
end the following: 
‘‘Subpart XII—Public Health Workforce 
‘‘SEC. 340L. PUBLIC HEALTH WORKFORCE CORPS. 
‘‘(a) ESTABLISHMENT.—There is established, within 
the Service, the Public Health Workforce Corps (in this 
subpart referred to as the ‘Corps’), for the purpose of en-
suring an adequate supply of public health professionals 
throughout the Nation. The Corps shall consist of— 
‘‘(1) such officers of the Regular and Reserve 
Corps of the Service as the Secretary may designate; 
and 
‘‘(2) such civilian employees of the United 
States as the Secretary may appoint. 
‘‘(b) ADMINISTRATION.—Except as provided in sub-
section (c), the Secretary shall carry out this subpart act-
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1954 
ing through the Administrator of the Health Resources 
and Services Administration. 
‘‘(c) PLACEMENT AND ASSIGNMENT.—The Secretary, 
acting through the Director of the Centers for Disease 
Control and Prevention, shall develop a methodology for 
placing and assigning Corps participants as public health 
professionals. Such methodology may allow for placing and 
assigning such participants in State, local, and tribal 
health departments and Federally qualified health centers 
(as defined in section 1861(aa)(4) of the Social Security 
Act). 
‘‘(d) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of subpart II shall, except as inconsistent with 
this subpart, apply to the Public Health Workforce Corps 
in the same manner and to the same extent as such provi-
sions apply to the National Health Service Corps estab-
lished under section 331. 
‘‘(e) REPORT.—The Secretary shall submit to the 
Congress an annual report on the programs carried out 
under this subpart. 
‘‘SEC. 340M. PUBLIC HEALTH WORKFORCE SCHOLARSHIP 
PROGRAM. 
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish the Public Health Workforce Scholarship Program 
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1955 
(referred to in this section as the ‘Program’) for the pur-
pose described in section 340L(a). 
‘‘(b) ELIGIBILITY.—To be eligible to participate in 
the Program, an individual shall— 
‘‘(1)(A) be accepted for enrollment, or be en-
rolled, as a full-time or part-time student in a course 
of study or program (approved by the Secretary) at 
an accredited graduate school or program of public 
health; or 
‘‘(B) have demonstrated expertise in public 
health and be accepted for enrollment, or be en-
rolled, as a full-time or part-time student in a course 
of study or program (approved by the Secretary) 
at— 
‘‘(i) an accredited graduate school or pro-
gram of nursing; health administration, man-
agement, or policy; preventive medicine; labora-
tory science; veterinary medicine; or dental 
medicine; or 
‘‘(ii) another accredited graduate school or 
program, as deemed appropriate by Secretary; 
‘‘(2) be eligible for, or hold, an appointment as 
a commissioned officer in the Regular or Reserve 
Corps of the Service or be eligible for selection for 
civilian service in the Corps; and 
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1956 
‘‘(3) sign and submit to the Secretary a written 
contract (described in subsection (c)) to serve full- 
time as a public health professional, upon the com-
pletion of the course of study or program involved, 
for the period of obligated service described in sub-
section (c)(2)(E). 
‘‘(c) CONTRACT.—The written contract between the 
Secretary and an individual under subsection (b)(3) shall 
contain— 
‘‘(1) an agreement on the part of the Secretary 
that the Secretary will— 
‘‘(A) provide the individual with a scholar-
ship for a period of years (not to exceed 4 aca-
demic years) during which the individual shall 
pursue an approved course of study or program 
to prepare the individual to serve in the public 
health workforce; and 
‘‘(B) accept (subject to the availability of 
appropriated funds) the individual into the 
Corps; 
‘‘(2) an agreement on the part of the individual 
that the individual will— 
‘‘(A) accept provision of such scholarship 
to the individual; 
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1957 
‘‘(B) maintain full-time or part-time enroll-
ment in the approved course of study or pro-
gram described in subsection (b)(1) until the in-
dividual completes that course of study or pro-
gram; 
‘‘(C) while enrolled in the approved course 
of study or program, maintain an acceptable 
level of academic standing (as determined by 
the educational institution offering such course 
of study or program); 
‘‘(D) if applicable, complete a residency or 
internship; and 
‘‘(E) serve full-time as a public health pro-
fessional for a period of time equal to the great-
er of— 
‘‘(i) 1 year for each academic year for 
which the individual was provided a schol-
arship under the Program; or 
‘‘(ii) 2 years; and 
‘‘(3) an agreement by both parties as to the na-
ture and extent of the scholarship assistance, which 
may include— 
‘‘(A) payment of reasonable educational ex-
penses of the individual, including tuition, fees, 
books, equipment, and laboratory expenses; and 
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1958 
‘‘(B) payment of a stipend of not more 
than $1,269 (plus, beginning with fiscal year 
2011, an amount determined by the Secretary 
on an annual basis to reflect inflation) per 
month for each month of the academic year in-
volved, with the dollar amount of such a stipend 
determined by the Secretary taking into consid-
eration whether the individual is enrolled full- 
time or part-time. 
‘‘(d) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of subpart III shall, except as inconsistent with 
this subpart, apply to the scholarship program under this 
section in the same manner and to the same extent as 
such provisions apply to the National Health Service 
Corps Scholarship Program established under section 
338A. 
‘‘SEC. 340N. PUBLIC HEALTH WORKFORCE LOAN REPAY-
MENT PROGRAM. 
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish the Public Health Workforce Loan Repayment Pro-
gram (referred to in this section as the ‘Program’) for the 
purpose described in section 340L(a). 
‘‘(b) ELIGIBILITY.—To be eligible to participate in 
the Program, an individual shall— 
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1959 
‘‘(1)(A) have a graduate degree from an accred-
ited school or program of public health; 
‘‘(B) have demonstrated expertise in public 
health and have a graduate degree in a course of 
study or program (approved by the Secretary) 
from— 
‘‘(i) an accredited school or program of 
nursing; health administration, management, or 
policy; preventive medicine; laboratory science; 
veterinary medicine; or dental medicine; or 
‘‘(ii) another accredited school or program 
approved by the Secretary; or 
‘‘(C) be enrolled as a full-time or part-time stu-
dent in the final year of a course of study or pro-
gram (approved by the Secretary) offered by a 
school or program described in subparagraph (A) or 
(B), leading to a graduate degree; 
‘‘(2) be eligible for, or hold, an appointment as 
a commissioned officer in the Regular or Reserve 
Corps of the Service or be eligible for selection for 
civilian service in the Corps; 
‘‘(3) if applicable, complete a residency or in-
ternship; and 
‘‘(4) sign and submit to the Secretary a written 
contract (described in subsection (c)) to serve full- 
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1960 
time as a public health professional for the period of 
obligated service described in subsection (c)(2). 
‘‘(c) CONTRACT.—The written contract between the 
Secretary and an individual under subsection (b)(4) shall 
contain— 
‘‘(1) an agreement by the Secretary to repay on 
behalf of the individual loans incurred by the indi-
vidual in the pursuit of the relevant public health 
workforce educational degree in accordance with the 
terms of the contract; 
‘‘(2) an agreement by the individual to serve 
full-time as a public health professional for a period 
of time equal to 2 years or such longer period as the 
individual may agree to; and 
‘‘(3) in the case of an individual described in 
subsection (b)(1)(C) who is in the final year of study 
and who has accepted employment as a public health 
professional, in accordance with subsection 340L(c), 
an agreement on the part of the individual to com-
plete the education or training, maintain an accept-
able level of academic standing (as determined by 
the educational institution offering the course of 
study or training), and serve the period of obligated 
service described in paragraph (2). 
‘‘(d) PAYMENTS.— 
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1961 
‘‘(1) IN GENERAL.—A loan repayment provided 
for an individual under a written contract under the 
Program shall consist of payment, in accordance 
with paragraph (2), on behalf of the individual of 
the principal, interest, and related expenses on gov-
ernment and commercial loans received by the indi-
vidual regarding the undergraduate or graduate edu-
cation of the individual (or both), which loans were 
made for reasonable educational expenses, including 
tuition, fees, books, equipment, and laboratory ex-
penses, incurred by the individual. 
‘‘(2) PAYMENTS FOR YEARS SERVED.— 
‘‘(A) IN GENERAL.—For each year of obli-
gated service that an individual contracts to 
serve under subsection (c), the Secretary may 
pay up to $35,000 (plus, beginning with fiscal 
year 2012, an amount determined by the Sec-
retary on an annual basis to reflect inflation) 
on behalf of the individual for loans described 
in paragraph (1). 
‘‘(B) REPAYMENT
SCHEDULE.—Any ar-
rangement made by the Secretary for the mak-
ing of loan repayments in accordance with this 
subsection shall provide that any repayments 
for a year of obligated service shall be made no 
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1962 
later than the end of the fiscal year in which 
the individual completes such year of service. 
‘‘(e) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of subpart III shall, except as inconsistent with 
this subpart, apply to the loan repayment program under 
this section in the same manner and to the same extent 
as such provisions apply to the National Health Service 
Corps Loan Repayment Program established under sec-
tion 338B.’’. 
SEC. 2232. ENHANCING THE PUBLIC HEALTH WORKFORCE. 
Section 765 (42 U.S.C. 295) is amended to read as 
follows: 
‘‘SEC. 765. ENHANCING THE PUBLIC HEALTH WORKFORCE. 
‘‘(a) PROGRAM.—The Secretary, acting through the 
Administrator of the Health Resources and Services Ad-
ministration and in consultation with the Director of the 
Centers for Disease Control and Prevention, shall estab-
lish a public health workforce training and enhancement 
program consisting of awarding grants and contracts 
under subsection (b). 
‘‘(b) GRANTS AND CONTRACTS.—The Secretary shall 
award grants and contracts to eligible entities— 
‘‘(1) to plan, develop, operate, or participate in, 
an accredited professional training program in the 
field of public health (including such a program in 
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1963 
nursing; health administration, management, or pol-
icy; preventive medicine; laboratory science; veteri-
nary medicine; or dental medicine) for members of 
the public health workforce including mid-career 
professionals; 
‘‘(2) to provide financial assistance in the form 
of traineeships and fellowships to students who are 
participants in any such program and who plan to 
specialize or work in the field of public health; 
‘‘(3) to plan, develop, operate, or participate in 
a program for the training of public health profes-
sionals who plan to teach in any program described 
in paragraph (1); and 
‘‘(4) to provide financial assistance in the form 
of traineeships and fellowships to public health pro-
fessionals who are participants in any program de-
scribed in paragraph (1) and who plan to teach in 
the field of public health, including nursing; health 
administration, management, or policy; preventive 
medicine; laboratory science; veterinary medicine; or 
dental medicine. 
‘‘(c) ELIGIBILITY.—To be eligible for a grant or con-
tract under subsection (a), an entity shall be— 
‘‘(1) an accredited health professions school, in-
cluding an accredited graduate school or program of 
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1964 
public health; nursing; health administration, man-
agement, or policy; preventive medicine; laboratory 
science; veterinary medicine; or dental medicine; 
‘‘(2) a State, local, or tribal health department; 
‘‘(3) a public or private nonprofit entity; or 
‘‘(4) a consortium of 2 or more entities de-
scribed in paragraphs (1) through (3). 
‘‘(d) PREFERENCE.—In awarding grants or contracts 
under this section, the Secretary shall give preference to 
entities that have a demonstrated record of the following: 
‘‘(1) Training the greatest percentage, or sig-
nificantly improving the percentage, of public health 
professionals who serve in underserved communities. 
‘‘(2) Training individuals who are from under-
represented minority groups or disadvantaged back-
grounds. 
‘‘(3) Training individuals in public health spe-
cialties experiencing a significant shortage of public 
health professionals (as determined by the Sec-
retary). 
‘‘(4) Training the greatest percentage, or sig-
nificantly improving the percentage, of public health 
professionals serving in the Federal Government or 
a State, local, or tribal government. 
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1965 
‘‘(e) REPORT.—The Secretary shall submit to the 
Congress an annual report on the program carried out 
under this section.’’. 
SEC. 2233. PUBLIC HEALTH TRAINING CENTERS. 
Section 766 (42 U.S.C. 295a) is amended— 
(1) in subsection (b)(1), by striking ‘‘in further-
ance of the goals established by the Secretary for 
the year 2000’’ and inserting ‘‘in furtherance of the 
goals established by the Secretary in the national 
prevention and wellness strategy under section 
3121’’; and 
(2) by adding at the end the following: 
‘‘(d) REPORT.—The Secretary shall submit to the 
Congress an annual report on the program carried out 
under this section.’’. 
SEC. 2234. PREVENTIVE MEDICINE AND PUBLIC HEALTH 
TRAINING GRANT PROGRAM. 
Section 768 (42 U.S.C. 295c) is amended to read as 
follows: 
‘‘SEC. 768. PREVENTIVE MEDICINE AND PUBLIC HEALTH 
TRAINING GRANT PROGRAM. 
‘‘(a) GRANTS.—The Secretary, acting through the 
Administrator of the Health Resources and Services Ad-
ministration and in consultation with the Director of the 
Centers for Disease Control and Prevention, shall award 
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1966 
grants to, or enter into contracts with, eligible entities to 
provide training to graduate medical residents in preven-
tive medicine specialties. 
‘‘(b) ELIGIBILITY.—To be eligible for a grant or con-
tract under subsection (a), an entity shall be— 
‘‘(1) an accredited school of public health or 
school of medicine or osteopathic medicine; 
‘‘(2) an accredited public or private hospital; 
‘‘(3) a State, local, or tribal health department; 
or 
‘‘(4) a consortium of 2 or more entities de-
scribed in paragraphs (1) through (3). 
‘‘(c) USE OF FUNDS.—Amounts received under a 
grant or contract under this section shall be used to— 
‘‘(1) plan, develop (including the development of 
curricula), operate, or participate in an accredited 
residency or internship program in preventive medi-
cine or public health; 
‘‘(2) defray the costs of practicum experiences, 
as required in such a program; and 
‘‘(3) establish, maintain, or improve— 
‘‘(A) academic administrative units (in-
cluding departments, divisions, or other appro-
priate units) in preventive medicine and public 
health; or 
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1967 
‘‘(B) programs that improve clinical teach-
ing in preventive medicine and public health. 
‘‘(d) REPORT.—The Secretary shall submit to the 
Congress an annual report on the program carried out 
under this section.’’. 
SEC. 2235. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—Section 799C, as added by section 
2216 of this division, is amended by adding at the end 
the following: 
‘‘(b) PUBLIC HEALTH WORKFORCE.—For the pur-
pose of carrying out subpart XII of part D of title III 
and sections 765, 766, and 768, in addition to any other 
amounts authorized to be appropriated for such purpose, 
there are authorized to be appropriated, out of any monies 
in the Public Health Investment Fund, the following: 
‘‘(1) $51,000,000 for fiscal year 2010. 
‘‘(2) $54,000,000 for fiscal year 2011. 
‘‘(3) $57,000,000 for fiscal year 2012. 
‘‘(4) $59,000,000 for fiscal year 2013. 
‘‘(5) $62,000,000 for fiscal year 2014. 
‘‘(6) $65,000,000 for fiscal year 2015. 
‘‘(7) $68,000,000 for fiscal year 2016. 
‘‘(8) $72,000,000 for fiscal year 2017. 
‘‘(9) $75,000,000 for fiscal year 2018. 
‘‘(10) $79,000,000 for fiscal year 2019.’’. 
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1968 
(b) EXISTING
AUTHORIZATION
OF
APPROPRIA-
TIONS.—Subpart (a) of section 770 (42 U.S.C. 295e) is 
amended by striking ‘‘2002’’ and inserting ‘‘2019’’. 
Subtitle D—Adapting Workforce to 
Evolving Health System Needs 
PART 1—HEALTH PROFESSIONS TRAINING FOR 
DIVERSITY 
SEC. 2241. SCHOLARSHIPS FOR DISADVANTAGED STU-
DENTS, LOAN REPAYMENTS AND FELLOW-
SHIPS REGARDING FACULTY POSITIONS, AND 
EDUCATIONAL ASSISTANCE IN THE HEALTH 
PROFESSIONS 
REGARDING 
INDIVIDUALS 
FROM DISADVANTAGED BACKGROUNDS. 
Paragraph (1) of section 738(a) (42 U.S.C. 293b(a)) 
is amended by striking ‘‘not more than $20,000’’ and all 
that follows through the end of the paragraph and insert-
ing: ‘‘not more than $35,000 (plus, beginning with fiscal 
year 2012, an amount determined by the Secretary on an 
annual basis to reflect inflation) of the principal and inter-
est of the educational loans of such individuals.’’ 
SEC. 2242. NURSING WORKFORCE DIVERSITY GRANTS. 
Subsection (b) of section 821 (42 U.S.C. 296m) is 
amended— 
(1) in the heading, by striking ‘‘GUIDANCE’’ 
and inserting ‘‘CONSULTATION’’; and 
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(2) by striking ‘‘shall take into consideration’’ 
and all that follows through ‘‘consult with nursing 
associations’’ and inserting ‘‘shall, as appropriate, 
consult with nursing associations’’. 
SEC. 2243. COORDINATION OF DIVERSITY AND CULTURAL 
COMPETENCY PROGRAMS. 
Title VII (42 U.S.C. 292 et seq.) is amended by in-
serting after section 739 the following: 
‘‘SEC. 739A. COORDINATION OF DIVERSITY AND CULTURAL 
COMPETENCY PROGRAMS. 
‘‘The Secretary shall, to the extent practicable, co-
ordinate the activities carried out under this part and sec-
tion 821 in order to enhance the effectiveness of such ac-
tivities and avoid duplication of effort.’’. 
PART 2—INTERDISCIPLINARY TRAINING 
PROGRAMS 
SEC. 2251. CULTURAL AND LINGUISTIC COMPETENCY 
TRAINING 
FOR 
HEALTH 
CARE 
PROFES-
SIONALS. 
Section 741 (42 U.S.C. 293e) is amended— 
(1) in the section heading, by striking ‘‘GRANTS 
FOR HEALTH PROFESSIONS EDUCATION’’ and in-
serting ‘‘CULTURAL AND LINGUISTIC COMPETENCY 
TRAINING FOR HEALTH CARE PROFESSIONALS’’; 
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(2) by redesignating subsection (b) as sub-
section (h); and 
(3) by striking subsection (a) and inserting the 
following: 
‘‘(a) PROGRAM.—The Secretary shall establish a cul-
tural and linguistic competency training program for 
health care professionals, including nurse professionals, 
consisting of awarding grants and contracts under sub-
section (b). 
‘‘(b) CULTURAL
AND
LINGUISTIC
COMPETENCY 
TRAINING.—The Secretary shall award grants and con-
tracts to eligible entities— 
‘‘(1) to test, develop, and evaluate models of 
cultural and linguistic competency training (includ-
ing continuing education) for health professionals; 
and 
‘‘(2) to implement cultural and linguistic com-
petency training programs for health professionals 
developed under paragraph (1) or otherwise. 
‘‘(c) ELIGIBILITY.—To be eligible for a grant or con-
tract under subsection (b), an entity shall be— 
‘‘(1) an accredited health professions school or 
program; 
‘‘(2) an academic health center; 
‘‘(3) a public or private nonprofit entity; or 
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