H. R. 3590—449 
(ii) a local health department; or 
(iii) an Indian tribe; 
(B) submit to the Secretary an application at such 
time, in such manner, and containing such information 
as the Secretary may require including a description of 
the program to be carried out under the grant; 
(C) design a strategy for improving the health of the 
55-to-64 year-old population through community-based 
public health interventions; and 
(D) demonstrate the capacity, if funded, to develop 
the relationships necessary with relevant health agencies, 
health care providers, community-based organizations, and 
insurers to carry out the activities described in paragraph 
(3), such relationships to include the identification of a 
community-based clinical partner, such as a community 
health center or rural health clinic. 
(3) USE OF FUNDS.— 
(A) IN GENERAL.—A State or local health department 
shall use amounts received under a grant under this sub-
section to carry out a program to provide the services 
described in this paragraph to individuals who are between 
55 and 64 years of age. 
(B) PUBLIC HEALTH INTERVENTIONS.— 
(i) IN GENERAL.—In developing and implementing 
such activities, a grantee shall collaborate with the 
Centers for Disease Control and Prevention and the 
Administration on Aging, and relevant local agencies 
and organizations. 
(ii) TYPES OF INTERVENTION ACTIVITIES.—Interven-
tion activities conducted under this subparagraph may 
include efforts to improve nutrition, increase physical 
activity, reduce tobacco use and substance abuse, 
improve mental health, and promote healthy lifestyles 
among the target population. 
(C) COMMUNITY PREVENTIVE SCREENINGS.— 
(i) IN GENERAL.—In addition to community-wide 
public health interventions, a State or local health 
department shall use amounts received under a grant 
under this subsection to conduct ongoing health 
screening to identify risk factors for cardiovascular 
disease, cancer, stroke, and diabetes among individuals 
in both urban and rural areas who are between 55 
and 64 years of age. 
(ii) TYPES
OF
SCREENING
ACTIVITIES.—Screening 
activities conducted under this subparagraph may 
include— 
(I) mental health/behavioral health and sub-
stance use disorders; 
(II) physical activity, smoking, and nutrition; 
and 
(III) any other measures deemed appropriate 
by the Secretary. 
(iii) MONITORING.—Grantees under this section 
shall maintain records of screening results under this 
subparagraph to establish the baseline data for moni-
toring the targeted population
H. R. 3590—450 
(D) CLINICAL REFERRAL/TREATMENT FOR CHRONIC DIS-
EASES.— 
(i) IN GENERAL.—A State or local health depart-
ment shall use amounts received under a grant under 
this subsection to ensure that individuals between 55 
and 64 years of age who are found to have chronic 
disease risk factors through the screening activities 
described in subparagraph (C)(ii), receive clinical 
referral/treatment for follow-up services to reduce such 
risk. 
(ii) MECHANISM.— 
(I) IDENTIFICATION
AND
DETERMINATION
OF 
STATUS.—With respect to each individual with risk 
factors for or having heart disease, stroke, 
diabetes, or any other condition for which such 
individual was screened under subparagraph (C), 
a grantee under this section shall determine 
whether or not such individual is covered under 
any public or private health insurance program. 
(II) 
INSURED
INDIVIDUALS.—An 
individual 
determined to be covered under a health insurance 
program under subclause (I) shall be referred by 
the grantee to the existing providers under such 
program or, if such individual does not have a 
current provider, to a provider who is in-network 
with respect to the program involved. 
(III) UNINSURED
INDIVIDUALS.—With respect 
to an individual determined to be uninsured under 
subclause (I), the grantee’s community-based clin-
ical partner described in paragraph (4)(D) shall 
assist the individual in determining eligibility for 
available public coverage options and identify other 
appropriate community health care resources and 
assistance programs. 
(iii) PUBLIC HEALTH INTERVENTION PROGRAM.—A 
State or local health department shall use amounts 
received under a grant under this subsection to enter 
into contracts with community health centers or rural 
health clinics and mental health and substance use 
disorder service providers to assist in the referral/treat-
ment of at risk patients to community resources for 
clinical follow-up and help determine eligibility for 
other public programs. 
(E) GRANTEE EVALUATION.—An eligible entity shall use 
amounts provided under a grant under this subsection 
to conduct activities to measure changes in the prevalence 
of chronic disease risk factors among participants. 
(4) PILOT PROGRAM EVALUATION.—The Secretary shall con-
duct an annual evaluation of the effectiveness of the pilot 
program under this subsection. In determining such effective-
ness, the Secretary shall consider changes in the prevalence 
of uncontrolled chronic disease risk factors among new Medicare 
enrollees (or individuals nearing enrollment, including those 
who are 63 and 64 years of age) who reside in States or 
localities receiving grants under this section as compared with 
national and historical data for those States and localities 
for the same population.
H. R. 3590—451 
(5) AUTHORIZATION OF APPROPRIATIONS.—There are author-
ized to be appropriated to carry out this subsection, such sums 
as may be necessary for each of fiscal years 2010 through 
2014. 
(b) EVALUATION AND PLAN FOR COMMUNITY-BASED PREVENTION 
AND WELLNESS PROGRAMS FOR MEDICARE BENEFICIARIES.— 
(1) IN GENERAL.—The Secretary shall conduct an evaluation 
of community-based prevention and wellness programs and 
develop a plan for promoting healthy lifestyles and chronic 
disease self-management for Medicare beneficiaries. 
(2) MEDICARE EVALUATION OF PREVENTION AND WELLNESS 
PROGRAMS.— 
(A) IN GENERAL.—The Secretary shall evaluate commu-
nity prevention and wellness programs including those that 
are sponsored by the Administration on Aging, are evi-
dence-based, and have demonstrated potential to help 
Medicare beneficiaries (particularly beneficiaries that have 
attained 65 years of age) reduce their risk of disease, 
disability, and injury by making healthy lifestyle choices, 
including exercise, diet, and self-management of chronic 
diseases. 
(B) EVALUATION.—The evaluation under subparagraph 
(A) shall consist of the following: 
(i) EVIDENCE REVIEW.—The Secretary shall review 
available evidence, literature, best practices, and 
resources that are relevant to programs that promote 
healthy lifestyles and reduce risk factors for the Medi-
care population. The Secretary may determine the 
scope of the evidence review and such issues to be 
considered, which shall include, at a minimum— 
(I) physical activity, nutrition, and obesity; 
(II) falls; 
(III) chronic disease self-management; and 
(IV) mental health. 
(ii) INDEPENDENT EVALUATION OF EVIDENCE-BASED 
COMMUNITY PREVENTION AND WELLNESS PROGRAMS.— 
The Administrator of the Centers for Medicare & Med-
icaid Services, in consultation with the Assistant Sec-
retary for Aging, shall, to the extent feasible and prac-
ticable, conduct an evaluation of existing community 
prevention and wellness programs that are sponsored 
by the Administration on Aging to assess the extent 
to which Medicare beneficiaries who participate in such 
programs— 
(I) reduce their health risks, improve their 
health outcomes, and adopt and maintain healthy 
behaviors; 
(II) improve their ability to manage their 
chronic conditions; and 
(III) reduce their utilization of health services 
and associated costs under the Medicare program 
for conditions that are amenable to improvement 
under such programs. 
(3) REPORT.—Not later than September 30, 2013, the Sec-
retary shall submit to Congress a report that includes— 
(A) recommendations for such legislation and adminis-
trative action as the Secretary determines appropriate to
H. R. 3590—452 
promote healthy lifestyles and chronic disease self-manage-
ment for Medicare beneficiaries; 
(B) any relevant findings relating to the evidence 
review under paragraph (2)(B)(i); and 
(C) the results of the evaluation under paragraph 
(2)(B)(ii). 
(4) FUNDING.—For purposes of carrying out this subsection, 
the Secretary shall provide for the transfer, from the Federal 
Hospital Insurance Trust Fund under section 1817 of the Social 
Security Act (42 U.S.C. 1395i) and the Federal Supplemental 
Medical Insurance Trust Fund under section 1841 of such Act 
(42 U.S.C. 1395t), in such proportion as the Secretary deter-
mines appropriate, of $50,000,000 to the Centers for Medicare 
& Medicaid Services Program Management Account. Amounts 
transferred under the preceding sentence shall remain available 
until expended. 
(5) ADMINISTRATION.—Chapter 35 of title 44, United States 
Code shall not apply to the this subsection. 
(6) MEDICARE BENEFICIARY.—In this subsection, the term 
‘‘Medicare beneficiary’’ means an individual who is entitled 
to benefits under part A of title XVIII of the Social Security 
Act and enrolled under part B of such title. 
SEC. 4203. REMOVING BARRIERS AND IMPROVING ACCESS TO 
WELLNESS FOR INDIVIDUALS WITH DISABILITIES. 
Title V of the Rehabilitation Act of 1973 (29 U.S.C. 791 et 
seq.) is amended by adding at the end of the following: 
‘‘SEC. 510. ESTABLISHMENT OF STANDARDS FOR ACCESSIBLE MED-
ICAL DIAGNOSTIC EQUIPMENT. 
‘‘(a) STANDARDS.—Not later than 24 months after the date 
of enactment of the Affordable Health Choices Act, the Architectural 
and Transportation Barriers Compliance Board shall, in consulta-
tion with the Commissioner of the Food and Drug Administration, 
promulgate regulatory standards in accordance with the Adminis-
trative Procedure Act (2 U.S.C. 551 et seq.) setting forth the min-
imum technical criteria for medical diagnostic equipment used in 
(or in conjunction with) physician’s offices, clinics, emergency rooms, 
hospitals, and other medical settings. The standards shall ensure 
that such equipment is accessible to, and usable by, individuals 
with accessibility needs, and shall allow independent entry to, use 
of, and exit from the equipment by such individuals to the maximum 
extent possible. 
‘‘(b) MEDICAL DIAGNOSTIC EQUIPMENT COVERED.—The stand-
ards issued under subsection (a) for medical diagnostic equipment 
shall apply to equipment that includes examination tables, examina-
tion chairs (including chairs used for eye examinations or proce-
dures, and dental examinations or procedures), weight scales, 
mammography equipment, x-ray machines, and other radiological 
equipment commonly used for diagnostic purposes by health profes-
sionals. 
‘‘(c) 
REVIEW
AND
AMENDMENT.—The 
Architectural 
and 
Transportation Barriers Compliance Board, in consultation with 
the Commissioner of the Food and Drug Administration, shall 
periodically review and, as appropriate, amend the standards in 
accordance with the Administrative Procedure Act (2 U.S.C. 551 
et seq.).’’.