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‘‘(1) of breast health, symptoms, and early diag-
nosis and treatment of breast cancer in young women, 
including specific risk factors such as family history 
of cancer and women that may be at high risk for 
breast cancer, such as Ashkenazi Jewish population; 
‘‘(2) on how to provide counseling to young 
women about their breast health, including knowledge 
of their family cancer history and importance of pro-
viding regular clinical breast examinations; 
‘‘(3) concerning the importance of discussing 
healthy behaviors, and increasing awareness of serv-
ices and programs available to address overall health 
and wellness, and making patient referrals to address 
tobacco cessation, good nutrition, and physical activ-
ity; 
‘‘(4) on when to refer patients to a health care 
provider with genetics expertise; 
‘‘(5) on how to provide counseling that addresses 
long-term survivorship and health concerns of young 
women diagnosed with breast cancer; and 
‘‘(6) on when to provide referrals to organiza-
tions and institutions that provide credible health in-
formation and substantive assistance and support to 
young women diagnosed with breast cancer. 
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‘‘(c) PREVENTION RESEARCH ACTIVITIES.—The Sec-
retary, acting through— 
‘‘(1) the Director of the Centers for Disease Con-
trol and Prevention, shall conduct prevention research 
on breast cancer in younger women, including— 
‘‘(A) behavioral, survivorship studies, and 
other research on the impact of breast cancer di-
agnosis on young women; 
‘‘(B) formative research to assist with the 
development of educational messages and infor-
mation for the public, targeted populations, and 
their families about breast health, breast cancer, 
and healthy lifestyles; 
‘‘(C) testing and evaluating existing and 
new social marketing strategies targeted at 
young women; and 
‘‘(D) surveys of health care providers and 
the public regarding knowledge, attitudes, and 
practices related to breast health and breast can-
cer prevention and control in high-risk popu-
lations; and 
‘‘(2) the Director of the National Institutes of 
Health, shall conduct research to develop and validate 
new screening tests and methods for prevention and 
early detection of breast cancer in young women. 
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‘‘(d) SUPPORT FOR YOUNG WOMEN DIAGNOSED WITH 
BREAST CANCER.— 
‘‘(1) IN GENERAL.—The Secretary shall award 
grants to organizations and institutions to provide 
health information from credible sources and sub-
stantive assistance directed to young women diag-
nosed with breast cancer and pre-neoplastic breast 
diseases. 
‘‘(2) PRIORITY.—In making grants under para-
graph (1), the Secretary shall give priority to appli-
cants that deal specifically with young women diag-
nosed with breast cancer and pre-neoplastic breast 
disease. 
‘‘(e) NO DUPLICATION OF EFFORT.—In conducting an 
education campaign or other program under subsections 
(a), (b), (c), or (d), the Secretary shall avoid duplicating 
other existing Federal breast cancer education efforts. 
‘‘(f) MEASUREMENT; REPORTING.—The Secretary, act-
ing through the Director of the Centers for Disease Control 
and Prevention, shall— 
‘‘(1) measure— 
‘‘(A) young women’s awareness regarding 
breast health, including knowledge of family can-
cer history, specific risk factors and early warn-
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ing signs, and young women’s proactive efforts 
at early detection; 
‘‘(B) the number or percentage of young 
women utilizing information regarding lifestyle 
interventions that foster healthy behaviors; 
‘‘(C) the number or percentage of young 
women receiving regular clinical breast exams; 
and 
‘‘(D) the number or percentage of young 
women who perform breast self exams, and the 
frequency of such exams, before the implementa-
tion of this section; 
‘‘(2) not less than every 3 years, measure the im-
pact of such activities; and 
‘‘(3) submit reports to the Congress on the results 
of such measurements. 
‘‘(g) DEFINITION.—In this section, the term ‘young 
women’ means women 15 to 44 years of age. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out subsections (a), (b), (c)(1), and (d), there are authorized 
to be appropriated $9,000,000 for each of the fiscal years 
2010 through 2014.’’. 
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Subtitle E—Provisions Relating to 
Title V 
SEC. 10501. AMENDMENTS TO THE PUBLIC HEALTH SERV-
ICE ACT, THE SOCIAL SECURITY ACT, AND 
TITLE V OF THIS ACT. 
(a) Section 5101 of this Act is amended— 
(1) in subsection (c)(2)(B)(i)(II), by inserting ‘‘, 
including representatives of small business and self- 
employed individuals’’ after ‘‘employers’’; 
(2) in subsection (d)(4)(A)— 
(A) by redesignating clause (iv) as clause 
(v); and 
(B) by inserting after clause (iii) the fol-
lowing: 
‘‘(iv) An analysis of, and recommenda-
tions for, eliminating the barriers to enter-
ing and staying in primary care, including 
provider compensation.’’; and 
(3) in subsection (i)(2)(B), by inserting ‘‘optom-
etrists, ophthalmologists,’’ after ‘‘occupational thera-
pists,’’. 
(b) Subtitle B of title V of this Act is amended by add-
ing at the end the following: 
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‘‘SEC. 5104. INTERAGENCY TASK FORCE TO ASSESS AND IM-
PROVE ACCESS TO HEALTH CARE IN THE 
STATE OF ALASKA. 
‘‘(a) ESTABLISHMENT.—There is established a task 
force to be known as the ‘Interagency Access to Health Care 
in Alaska Task Force’ (referred to in this section as the 
‘Task Force’). 
‘‘(b) DUTIES.—The Task Force shall— 
‘‘(1) assess access to health care for beneficiaries 
of Federal health care systems in Alaska; and 
‘‘(2) develop a strategy for the Federal Govern-
ment to improve delivery of health care to Federal 
beneficiaries in the State of Alaska. 
‘‘(c) MEMBERSHIP.—The Task Force shall be com-
prised of Federal members who shall be appointed, not later 
than 45 days after the date of enactment of this Act, as 
follows: 
‘‘(1) The Secretary of Health and Human Serv-
ices shall appoint one representative of each of the fol-
lowing: 
‘‘(A) The Department of Health and 
Human Services. 
‘‘(B) The Centers for Medicare and Med-
icaid Services. 
‘‘(C) The Indian Health Service. 
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‘‘(2) The Secretary of Defense shall appoint one 
representative of the TRICARE Management Activity. 
‘‘(3) The Secretary of the Army shall appoint 
one representative of the Army Medical Department. 
‘‘(4) The Secretary of the Air Force shall appoint 
one representative of the Air Force, from among offi-
cers at the Air Force performing medical service func-
tions. 
‘‘(5) The Secretary of Veterans Affairs shall ap-
point one representative of each of the following: 
‘‘(A) The Department of Veterans Affairs. 
‘‘(B) The Veterans Health Administration. 
‘‘(6) The Secretary of Homeland Security shall 
appoint one representative of the United States Coast 
Guard. 
‘‘(d) CHAIRPERSON.—One chairperson of the Task 
Force shall be appointed by the Secretary at the time of 
appointment of members under subsection (c), selected from 
among the members appointed under paragraph (1). 
‘‘(e) MEETINGS.—The Task Force shall meet at the call 
of the chairperson. 
‘‘(f) REPORT.—Not later than 180 days after the date 
of enactment of this Act, the Task Force shall submit to 
Congress a report detailing the activities of the Task Force 
and containing the findings, strategies, recommendations, 
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policies, and initiatives developed pursuant to the duty de-
scribed in subsection (b)(2). In preparing such report, the 
Task Force shall consider completed and ongoing efforts by 
Federal agencies to improve access to health care in the 
State of Alaska. 
‘‘(g) TERMINATION.—The Task Force shall be termi-
nated on the date of submission of the report described in 
subsection (f).’’. 
(c) Section 399V of the Public Health Service Act, as 
added by section 5313, is amended— 
(1) in subsection (b)(4), by striking ‘‘identify, 
educate, refer, and enroll’’ and inserting ‘‘identify 
and refer’’; and 
(2) in subsection (k)(1), by striking ‘‘, as defined 
by the Department of Labor as Standard Occupa-
tional Classification [21–1094]’’. 
(d) Section 738(a)(3) of the Public Health Service Act 
(42 U.S.C. 293b(a)(3)) is amended by inserting ‘‘schools of-
fering physician assistant education programs,’’ after ‘‘pub-
lic health,’’. 
(e) Subtitle D of title V of this Act is amended by add-
ing at the end the following: 
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‘‘SEC. 5316. DEMONSTRATION GRANTS FOR FAMILY NURSE 
PRACTITIONER TRAINING PROGRAMS. 
‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 
of Health and Human Services (referred to in this section 
as the ‘Secretary’) shall establish a training demonstration 
program for family nurse practitioners (referred to in this 
section as the ‘program’) to employ and provide 1-year 
training for nurse practitioners who have graduated from 
a nurse practitioner program for careers as primary care 
providers in Federally qualified health centers (referred to 
in this section as ‘FQHCs’) and nurse-managed health clin-
ics (referred to in this section as ‘NMHCs’). 
‘‘(b) PURPOSE.—The purpose of the program is to en-
able each grant recipient to— 
‘‘(1) provide new nurse practitioners with clin-
ical training to enable them to serve as primary care 
providers in FQHCs and NMHCs; 
‘‘(2) train new nurse practitioners to work under 
a model of primary care that is consistent with the 
principles set forth by the Institute of Medicine and 
the needs of vulnerable populations; and 
‘‘(3) create a model of FQHC and NMHC train-
ing for nurse practitioners that may be replicated na-
tionwide. 
‘‘(c) GRANTS.—The Secretary shall award 3-year 
grants to eligible entities that meet the requirements estab-
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lished by the Secretary, for the purpose of operating the 
nurse practitioner primary care programs described in sub-
section (a) in such entities. 
‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall— 
‘‘(1)(A) be a FQHC as defined in section 
1861(aa) of the Social Security Act (42 U.S.C. 
1395x(aa)); or 
‘‘(B) be a nurse-managed health clinic, as de-
fined in section 330A–1 of the Public Health Service 
Act (as added by section 5208 of this Act); and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(e) PRIORITY IN AWARDING GRANTS.—In awarding 
grants under this section, the Secretary shall give priority 
to eligible entities that— 
‘‘(1) demonstrate sufficient infrastructure in size, 
scope, and capacity to undertake the requisite train-
ing of a minimum of 3 nurse practitioners per year, 
and to provide to each awardee 12 full months of full- 
time, paid employment and benefits consistent with 
the benefits offered to other full-time employees of such 
entity; 
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‘‘(2) will assign not less than 1 staff nurse prac-
titioner or physician to each of 4 precepted clinics; 
‘‘(3) will provide to each awardee specialty rota-
tions, including specialty training in prenatal care 
and women’s health, adult and child psychiatry, or-
thopedics, geriatrics, and at least 3 other high-volume, 
high-burden specialty areas; 
‘‘(4) provide sessions on high-volume, high-risk 
health problems and have a record of training health 
care professionals in the care of children, older adults, 
and underserved populations; and 
‘‘(5) collaborate with other safety net providers, 
schools, colleges, and universities that provide health 
professions training. 
‘‘(f) ELIGIBILITY OF NURSE PRACTITIONERS.— 
‘‘(1) IN GENERAL.—To be eligible for acceptance 
to a program funded through a grant awarded under 
this section, an individual shall— 
‘‘(A) be licensed or eligible for licensure in 
the State in which the program is located as an 
advanced practice registered nurse or advanced 
practice nurse and be eligible or board-certified 
as a family nurse practitioner; and 
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‘‘(B) demonstrate commitment to a career 
as a primary care provider in a FQHC or in a 
NMHC. 
‘‘(2) PREFERENCE.—In selecting awardees under 
the program, each grant recipient shall give pref-
erence to bilingual candidates that meet the require-
ments described in paragraph (1). 
‘‘(3) DEFERRAL
OF
CERTAIN
SERVICE.—The 
starting date of required service of individuals in the 
National Health Service Corps Service program 
under title II of the Public Health Service Act (42 
U.S.C. 202 et seq.) who receive training under this 
section shall be deferred until the date that is 22 days 
after the date of completion of the program. 
‘‘(g) GRANT AMOUNT.—Each grant awarded under 
this section shall be in an amount not to exceed $600,000 
per year. A grant recipient may carry over funds from 1 
fiscal year to another without obtaining approval from the 
Secretary. 
‘‘(h) TECHNICAL
ASSISTANCE
GRANTS.—The Sec-
retary may award technical assistance grants to 1 or more 
FQHCs or NMHCs that have demonstrated expertise in es-
tablishing a nurse practitioner residency training program. 
Such technical assistance grants shall be for the purpose 
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of providing technical assistance to other recipients of 
grants under subsection (c). 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated such 
sums as may be necessary for each of fiscal years 2011 
through 2014.’’. 
(f)(1) Section 399W of the Public Health Service Act, 
as added by section 5405, is redesignated as section 399V– 
1. 
(2) Section 399V–1 of the Public Health Service Act, 
as so redesignated, is amended in subsection (b)(2)(A) by 
striking ‘‘and the departments of 1 or more health profes-
sions schools in the State that train providers in primary 
care’’ and inserting ‘‘and the departments that train pro-
viders in primary care in 1 or more health professions 
schools in the State’’. 
(3) Section 934 of the Public Health Service Act, as 
added by section 3501, is amended by striking ‘‘399W’’ each 
place such term appears and inserting ‘‘399V–1’’. 
(4) Section 935(b) of the Public Health Service Act, 
as added by section 3503, is amended by striking ‘‘399W’’ 
and inserting ‘‘399V–1’’. 
(g) Part P of title III of the Public Health Service 
Act 42 U.S.C. 280g et seq.), as amended by section 10411, 
is amended by adding at the end the following: 
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‘‘SEC. 399V–3. NATIONAL DIABETES PREVENTION PROGRAM. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, 
shall establish a national diabetes prevention program (re-
ferred to in this section as the ‘program’) targeted at adults 
at high risk for diabetes in order to eliminate the prevent-
able burden of diabetes. 
‘‘(b) PROGRAM ACTIVITIES.—The program described 
in subsection (a) shall include— 
‘‘(1) a grant program for community-based dia-
betes prevention program model sites; 
‘‘(2) a program within the Centers for Disease 
Control and Prevention to determine eligibility of en-
tities to deliver community-based diabetes prevention 
services; 
‘‘(3) a training and outreach program for life-
style intervention instructors; and 
‘‘(4) evaluation, monitoring and technical assist-
ance, and applied research carried out by the Centers 
for Disease Control and Prevention. 
‘‘(c) ELIGIBLE ENTITIES.—To be eligible for a grant 
under subsection (b)(1), an entity shall be a State or local 
health department, a tribal organization, a national net-
work of community-based non-profits focused on health and 
wellbeing, an academic institution, or other entity, as the 
Secretary determines. 
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‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for each 
of fiscal years 2010 through 2014.’’. 
(h) The provisions of, and amendment made by, sec-
tion 5501(c) of this Act are repealed. 
(i)(1) The provisions of, and amendments made by, 
section 5502 of this Act are repealed. 
(2)(A) Section 1861(aa)(3)(A) of the Social Security 
Act (42 U.S.C. 1395w(aa)(3)(A)) is amended to read as fol-
lows: 
‘‘(A) services of the type described in subpara-
graphs (A) through (C) of paragraph (1) and preven-
tive services (as defined in section 1861(ddd)(3)); 
and’’. 
(B) The amendment made by subparagraph (A) shall 
apply to services furnished on or after January 1, 2011. 
(3)(A) Section 1834 of the Social Security Act (42 
U.S.C. 1395m), as amended by section 4105, is amended 
by adding at the end the following new subsection: 
‘‘(o) DEVELOPMENT AND IMPLEMENTATION OF PRO-
SPECTIVE PAYMENT SYSTEM.— 
‘‘(1) DEVELOPMENT.— 
‘‘(A) IN GENERAL.—The Secretary shall de-
velop a prospective payment system for payment 
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for Federally qualified health center services fur-
nished by Federally qualified health centers 
under this title. Such system shall include a 
process for appropriately describing the services 
furnished by Federally qualified health centers 
and shall establish payment rates for specific 
payment codes based on such appropriate de-
scriptions of services. Such system shall be estab-
lished to take into account the type, intensity, 
and duration of services furnished by Federally 
qualified health centers. Such system may in-
clude adjustments, including geographic adjust-
ments, determined appropriate by the Secretary. 
‘‘(B) COLLECTION OF DATA AND EVALUA-
TION.—By not later than January 1, 2011, the 
Secretary shall require Federally qualified health 
centers to submit to the Secretary such informa-
tion as the Secretary may require in order to de-
velop and implement the prospective payment 
system under this subsection, including the re-
porting of services using HCPCS codes. 
‘‘(2) IMPLEMENTATION.— 
‘‘(A) IN
GENERAL.—Notwithstanding sec-
tion 1833(a)(3)(A), the Secretary shall provide, 
for cost reporting periods beginning on or after 
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October 1, 2014, for payments of prospective 
payment rates for Federally qualified health cen-
ter services furnished by Federally qualified 
health centers under this title in accordance with 
the prospective payment system developed by the 
Secretary under paragraph (1). 
‘‘(B) PAYMENTS.— 
‘‘(i) INITIAL
PAYMENTS.—The Sec-
retary shall implement such prospective 
payment system so that the estimated aggre-
gate amount of prospective payment rates 
(determined prior to the application of sec-
tion 1833(a)(1)(Z)) under this title for Fed-
erally qualified health center services in the 
first year that such system is implemented 
is equal to 100 percent of the estimated 
amount of reasonable costs (determined 
without the application of a per visit pay-
ment limit or productivity screen and prior 
to 
the 
application 
of 
section 
1866(a)(2)(A)(ii)) that would have occurred 
for such services under this title in such 
year if the system had not been imple-
mented. 
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‘‘(ii) 
PAYMENTS
IN
SUBSEQUENT 
YEARS.—Payment rates in years after the 
year of implementation of such system shall 
be the payment rates in the previous year 
increased— 
‘‘(I) in the first year after imple-
mentation of such system, by the per-
centage increase in the MEI (as de-
fined in section 1842(i)(3)) for the 
year involved; and 
‘‘(II) in subsequent years, by the 
percentage increase in a market basket 
of Federally qualified health center 
goods and services as promulgated 
through regulations, or if such an 
index is not available, by the percent-
age increase in the MEI (as defined in 
section 1842(i)(3)) for the year in-
volved. 
‘‘(C) PREPARATION FOR PPS IMPLEMENTA-
TION.—Notwithstanding any other provision of 
law, the Secretary may establish and implement 
by program instruction or otherwise the payment 
codes to be used under the prospective payment 
system under this section.’’. 
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(B) Section 1833(a)(1) of the Social Security Act (42 
U.S.C. 1395l(a)(1)), as amended by section 4104, is amend-
ed— 
(i) by striking ‘‘and’’ before ‘‘(Y)’’; and 
(ii) by inserting before the semicolon at the end 
the following: ‘‘, and (Z) with respect to Federally 
qualified health center services for which payment is 
made under section 1834(o), the amounts paid shall 
be 80 percent of the lesser of the actual charge or the 
amount determined under such section’’. 
(C) Section 1833(a) of the Social Security Act (42 
U.S.C. 1395l(a)) is amended— 
(i) in paragraph (3)(B)(i)— 
(I) by inserting ‘‘(I)’’ after ‘‘otherwise been 
provided’’; and 
(II) by inserting ‘‘, or (II) in the case of 
such services furnished on or after the implemen-
tation date of the prospective payment system 
under section 1834(o), under such section (cal-
culated as if ‘100 percent’ were substituted for 
‘80 percent’ in such section) for such services if 
the individual had not been so enrolled’’ after 
‘‘been so enrolled’’; and 
(ii) by adding at the end the following flush sen-
tence: 
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‘‘Paragraph (3)(A) shall not apply to Federally 
qualified health center services furnished on or after 
the implementation date of the prospective payment 
system under section 1834(0).’’. 
(j) Section 5505 is amended by adding at the end the 
following new subsection: 
‘‘(d) APPLICATION.—The amendments made by this 
section shall not be applied in a manner that requires re-
opening of any settled cost reports as to which there is not 
a jurisdictionally proper appeal pending as of the date of 
the enactment of this Act on the issue of payment for indi-
rect costs of medical education under section 1886(d)(5)(B) 
of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) or 
for direct graduate medical education costs under section 
1886(h) of such Act (42 U.S.C. 1395ww(h)).’’. 
(k) Subtitle G of title V of this Act is amended by add-
ing at the end the following: 
‘‘SEC. 5606. STATE GRANTS TO HEALTH CARE PROVIDERS 
WHO PROVIDE SERVICES TO A HIGH PER-
CENTAGE 
OF 
MEDICALLY 
UNDERSERVED 
POPULATIONS OR OTHER SPECIAL POPU-
LATIONS. 
‘‘(a) IN GENERAL.—A State may award grants to 
health care providers who treat a high percentage, as deter-
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mined by such State, of medically underserved populations 
or other special populations in such State. 
‘‘(b) SOURCE OF FUNDS.—A grant program estab-
lished by a State under subsection (a) may not be estab-
lished within a department, agency, or other entity of such 
State that administers the Medicaid program under title 
XIX of the Social Security Act (42 U.S.C. 1396 et seq.), 
and no Federal or State funds allocated to such Medicaid 
program, the Medicare program under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.), or the 
TRICARE program under chapter 55 of title 10, United 
States Code, may be used to award grants or to pay admin-
istrative costs associated with a grant program established 
under subsection (a).’’. 
(l) Part C of title VII of the Public Health Service 
Act (42 U.S.C. 293k et seq.) is amended— 
(1) after the part heading, by inserting the fol-
lowing: 
‘‘Subpart I—Medical Training Generally’’; 
and 
(2) by inserting at the end the following: 
‘‘Subpart II—Training in Underserved Communities 
‘‘SEC. 749B. RURAL PHYSICIAN TRAINING GRANTS. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Administrator of the Health Resources and Services Admin-
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istration, shall establish a grant program for the purposes 
of assisting eligible entities in recruiting students most like-
ly to practice medicine in underserved rural communities, 
providing rural-focused training and experience, and in-
creasing the number of recent allopathic and osteopathic 
medical school graduates who practice in underserved rural 
communities. 
‘‘(b) ELIGIBLE ENTITIES.—In order to be eligible to 
receive a grant under this section, an entity shall— 
‘‘(1) be a school of allopathic or osteopathic med-
icine accredited by a nationally recognized accred-
iting agency or association approved by the Secretary 
for this purpose, or any combination or consortium of 
such schools; and 
‘‘(2) submit an application to the Secretary that 
includes a certification that such entity will use 
amounts provided to the institution as described in 
subsection (d)(1). 
‘‘(c) PRIORITY.—In awarding grant funds under this 
section, the Secretary shall give priority to eligible entities 
that— 
‘‘(1) demonstrate a record of successfully train-
ing students, as determined by the Secretary, who 
practice medicine in underserved rural communities; 
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‘‘(2) demonstrate that an existing academic pro-
gram of the eligible entity produces a high percentage, 
as determined by the Secretary, of graduates from 
such program who practice medicine in underserved 
rural communities; 
‘‘(3) demonstrate rural community institutional 
partnerships, through such mechanisms as matching 
or contributory funding, documented in-kind services 
for implementation, or existence of training partners 
with interprofessional expertise in community health 
center training locations or other similar facilities; or 
‘‘(4) submit, as part of the application of the en-
tity under subsection (b), a plan for the long-term 
tracking of where the graduates of such entity practice 
medicine. 
‘‘(d) USE OF FUNDS.— 
‘‘(1) ESTABLISHMENT.—An eligible entity receiv-
ing a grant under this section shall use the funds 
made available under such grant to establish, im-
prove, or expand a rural-focused training program 
(referred to in this section as the ‘Program’) meeting 
the requirements described in this subsection and to 
carry out such program. 
‘‘(2) STRUCTURE OF PROGRAM.—An eligible en-
tity shall— 
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‘‘(A) enroll no fewer than 10 students per 
class year into the Program; and 
‘‘(B) develop criteria for admission to the 
Program that gives priority to students— 
‘‘(i) who have originated from or lived 
for a period of 2 or more years in an un-
derserved rural community; and 
‘‘(ii) who express a commitment to 
practice medicine in an underserved rural 
community. 
‘‘(3) CURRICULA.—The Program shall require 
students to enroll in didactic coursework and clinical 
experience particularly applicable to medical practice 
in underserved rural communities, including— 
‘‘(A) clinical rotations in underserved rural 
communities, and in applicable specialties, or 
other coursework or clinical experience deemed 
appropriate by the Secretary; and 
‘‘(B) in addition to core school curricula, 
additional coursework or training experiences fo-
cused on medical issues prevalent in underserved 
rural communities. 
‘‘(4) RESIDENCY
PLACEMENT
ASSISTANCE.— 
Where available, the Program shall assist all students 
of the Program in obtaining clinical training experi-
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ences in locations with postgraduate programs offer-
ing residency training opportunities in underserved 
rural communities, or in local residency training pro-
grams that support and train physicians to practice 
in underserved rural communities. 
‘‘(5) PROGRAM
STUDENT
COHORT
SUPPORT.— 
The Program shall provide and require all students of 
the Program to participate in group activities de-
signed to further develop, maintain, and reinforce the 
original commitment of such students to practice in 
an underserved rural community. 
‘‘(e) ANNUAL REPORTING.—An eligible entity receiv-
ing a grant under this section shall submit an annual re-
port to the Secretary on the success of the Program, based 
on criteria the Secretary determines appropriate, including 
the residency program selection of graduating students who 
participated in the Program. 
‘‘(f) REGULATIONS.—Not later than 60 days after the 
date of enactment of this section, the Secretary shall by reg-
ulation define ‘underserved rural community’ for purposes 
of this section. 
‘‘(g) SUPPLEMENT NOT SUPPLANT.—Any eligible enti-
ty receiving funds under this section shall use such funds 
to supplement, not supplant, any other Federal, State, and 
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‘‘(iv) for which the medical loss ratio 
(determined in a manner consistent with 
the determination of such ratio under sec-
tion 2718(b)(1)(A) of the Public Health 
Service Act) with respect to the individual 
insurance market for such entity for the cal-
endar year is not less than 100 percent, 
‘‘(D) any entity— 
‘‘(i)(I) which is incorporated as a non-
profit corporation under a State law, or 
‘‘(II) which is described in section 
501(c)(4) of the Internal Revenue Code of 
1986 and the activities of which consist of 
providing commercial-type insurance (with-
in the meaning of section 501(m) of such 
Code), and 
‘‘(ii) for which the medical loss ratio 
(as so determined)— 
‘‘(I) with respect to each of the in-
dividual, small group, and large group 
insurance markets for such entity for 
the calendar year is not less than 90 
percent, and 
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(A) IN GENERAL.—Paragraph (1) of section 
23(b) of the Internal Revenue Code of 1986 (re-
lating to dollar limitation) is amended by strik-
ing ‘‘$10,000’’ and inserting ‘‘$13,170’’. 
(B) CHILD WITH SPECIAL NEEDS.—Para-
graph (3) of section 23(a) of such Code (relating 
to $10,000 credit for adoption of child with spe-
cial needs regardless of expenses) is amended— 
(i) in the text by striking ‘‘$10,000’’ 
and inserting ‘‘$13,170’’, and 
(ii) 
in 
the 
heading 
by 
striking 
‘‘$10,000’’ and inserting ‘‘$13,170’’. 
(C) CONFORMING
AMENDMENT
TO
INFLA-
TION ADJUSTMENT.—Subsection (h) of section 23 
of such Code (relating to adjustments for infla-
tion) is amended to read as follows: 
‘‘(h) ADJUSTMENTS FOR INFLATION.— 
‘‘(1) DOLLAR
LIMITATIONS.—In the case of a 
taxable year beginning after December 31, 2010, each 
of the dollar amounts in subsections (a)(3) and (b)(1) 
shall be increased by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar year 
in which the taxable year begins, determined by 
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