H. R. 3590—453 
SEC. 4204. IMMUNIZATIONS. 
(a) STATE AUTHORITY TO PURCHASE RECOMMENDED VACCINES 
FOR ADULTS.—Section 317 of the Public Health Service Act (42 
U.S.C. 247b) is amended by adding at the end the following: 
‘‘(l) AUTHORITY
TO PURCHASE RECOMMENDED VACCINES
FOR 
ADULTS.— 
‘‘(1) IN GENERAL.—The Secretary may negotiate and enter 
into contracts with manufacturers of vaccines for the purchase 
and delivery of vaccines for adults as provided for under sub-
section (e). 
‘‘(2) STATE
PURCHASE.—A State may obtain additional 
quantities of such adult vaccines (subject to amounts specified 
to the Secretary by the State in advance of negotiations) 
through the purchase of vaccines from manufacturers at the 
applicable price negotiated by the Secretary under this sub-
section.’’. 
(b) DEMONSTRATION PROGRAM TO IMPROVE IMMUNIZATION COV-
ERAGE.—Section 317 of the Public Health Service Act (42 U.S.C. 
247b), as amended by subsection (a), is further amended by adding 
at the end the following: 
‘‘(m) DEMONSTRATION PROGRAM TO IMPROVE IMMUNIZATION 
COVERAGE.— 
‘‘(1) IN
GENERAL.—The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, 
shall establish a demonstration program to award grants to 
States to improve the provision of recommended immunizations 
for children, adolescents, and adults through the use of evi-
dence-based, population-based interventions for high-risk popu-
lations. 
‘‘(2) STATE PLAN.—To be eligible for a grant under para-
graph (1), a State shall submit to the Secretary an application 
at such time, in such manner, and containing such information 
as the Secretary may require, including a State plan that 
describes the interventions to be implemented under the grant 
and how such interventions match with local needs and 
capabilities, as determined through consultation with local 
authorities. 
‘‘(3) USE OF FUNDS.—Funds received under a grant under 
this subsection shall be used to implement interventions that 
are recommended by the Task Force on Community Preventive 
Services (as established by the Secretary, acting through the 
Director of the Centers for Disease Control and Prevention) 
or other evidence-based interventions, including— 
‘‘(A) providing immunization reminders or recalls for 
target populations of clients, patients, and consumers; 
‘‘(B) educating targeted populations and health care 
providers concerning immunizations in combination with 
one or more other interventions; 
‘‘(C) reducing out-of-pocket costs for families for vac-
cines and their administration; 
‘‘(D) carrying out immunization-promoting strategies 
for participants or clients of public programs, including 
assessments of immunization status, referrals to health 
care providers, education, provision of on-site immuniza-
tions, or incentives for immunization;
H. R. 3590—454 
‘‘(E) providing for home visits that promote immuniza-
tion through education, assessments of need, referrals, 
provision of immunizations, or other services; 
‘‘(F) providing reminders or recalls for immunization 
providers; 
‘‘(G) conducting assessments of, and providing feedback 
to, immunization providers; 
‘‘(H) any combination of one or more interventions 
described in this paragraph; or 
‘‘(I) immunization information systems to allow all 
States to have electronic databases for immunization 
records. 
‘‘(4) CONSIDERATION.—In awarding grants under this sub-
section, the Secretary shall consider any reviews or rec-
ommendations of the Task Force on Community Preventive 
Services. 
‘‘(5) EVALUATION.—Not later than 3 years after the date 
on which a State receives a grant under this subsection, the 
State shall submit to the Secretary an evaluation of progress 
made toward improving immunization coverage rates among 
high-risk populations within the State. 
‘‘(6) REPORT TO CONGRESS.—Not later than 4 years after 
the date of enactment of the Affordable Health Choices Act, 
the Secretary shall submit to Congress a report concerning 
the effectiveness of the demonstration program established 
under this subsection together with recommendations on 
whether to continue and expand such program. 
‘‘(7) AUTHORIZATION OF APPROPRIATIONS.—There is author-
ized to be appropriated to carry out this subsection, such sums 
as may be necessary for each of fiscal years 2010 through 
2014.’’. 
(c) REAUTHORIZATION
OF
IMMUNIZATION
PROGRAM.—Section 
317(j) of the Public Health Service Act (42 U.S.C. 247b(j)) is 
amended— 
(1) in paragraph (1), by striking ‘‘for each of the fiscal 
years 1998 through 2005’’; and 
(2) in paragraph (2), by striking ‘‘after October 1, 1997,’’. 
(d) RULE OF CONSTRUCTION REGARDING ACCESS TO IMMUNIZA-
TIONS.—Nothing in this section (including the amendments made 
by this section), or any other provision of this Act (including any 
amendments made by this Act) shall be construed to decrease 
children’s access to immunizations. 
(e) GAO STUDY AND REPORT ON MEDICARE BENEFICIARY ACCESS 
TO VACCINES.— 
(1) STUDY.—The Comptroller General of the United States 
(in this section referred to as the ‘‘Comptroller General’’) shall 
conduct a study on the ability of Medicare beneficiaries who 
were 65 years of age or older to access routinely recommended 
vaccines covered under the prescription drug program under 
part D of title XVIII of the Social Security Act over the period 
since the establishment of such program. Such study shall 
include the following: 
(A) An analysis and determination of— 
(i) the number of Medicare beneficiaries who were 
65 years of age or older and were eligible for a routinely 
recommended vaccination that was covered under part 
D;
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(ii) the number of such beneficiaries who actually 
received a routinely recommended vaccination that was 
covered under part D; and 
(iii) any barriers to access by such beneficiaries 
to routinely recommended vaccinations that were cov-
ered under part D. 
(B) A summary of the findings and recommendations 
by government agencies, departments, and advisory bodies 
(as well as relevant professional organizations) on the 
impact of coverage under part D of routinely recommended 
adult immunizations for access to such immunizations by 
Medicare beneficiaries. 
(2) REPORT.—Not later than June 1, 2011, the Comptroller 
General shall submit to the appropriate committees of jurisdic-
tion of the House of Representatives and the Senate a report 
containing the results of the study conducted under paragraph 
(1), together with recommendations for such legislation and 
administrative action as the Comptroller General determines 
appropriate. 
(3) FUNDING.—Out of any funds in the Treasury not other-
wise appropriated, there are appropriated $1,000,000 for fiscal 
year 2010 to carry out this subsection. 
SEC. 4205. NUTRITION LABELING OF STANDARD MENU ITEMS AT 
CHAIN RESTAURANTS. 
(a) TECHNICAL AMENDMENTS.—Section 403(q)(5)(A) of the Fed-
eral Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)(A)) is 
amended— 
(1) in subitem (i), by inserting at the beginning ‘‘except 
as provided in clause (H)(ii)(III),’’; and 
(2) in subitem (ii), by inserting at the beginning ‘‘except 
as provided in clause (H)(ii)(III),’’. 
(b) LABELING REQUIREMENTS.—Section 403(q)(5) of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)) is amended 
by adding at the end the following: 
‘‘(H) RESTAURANTS, RETAIL
FOOD
ESTABLISHMENTS, 
AND 
VENDING MACHINES.— 
‘‘(i) GENERAL REQUIREMENTS FOR RESTAURANTS AND SIMILAR 
RETAIL FOOD ESTABLISHMENTS.—Except for food described in 
subclause (vii), in the case of food that is a standard menu 
item that is offered for sale in a restaurant or similar retail 
food establishment that is part of a chain with 20 or more 
locations doing business under the same name (regardless of 
the type of ownership of the locations) and offering for sale 
substantially the same menu items, the restaurant or similar 
retail food establishment shall disclose the information 
described in subclauses (ii) and (iii). 
‘‘(ii) INFORMATION
REQUIRED
TO
BE
DISCLOSED
BY
RES-
TAURANTS AND RETAIL FOOD ESTABLISHMENTS.—Except as pro-
vided in subclause (vii), the restaurant or similar retail food 
establishment shall disclose in a clear and conspicuous 
manner— 
‘‘(I)(aa) in a nutrient content disclosure statement adja-
cent to the name of the standard menu item, so as to 
be clearly associated with the standard menu item, on 
the menu listing the item for sale, the number of calories
H. R. 3590—456 
contained in the standard menu item, as usually prepared 
and offered for sale; and 
‘‘(bb) a succinct statement concerning suggested daily 
caloric intake, as specified by the Secretary by regulation 
and posted prominently on the menu and designed to 
enable the public to understand, in the context of a total 
daily diet, the significance of the caloric information that 
is provided on the menu; 
‘‘(II)(aa) in a nutrient content disclosure statement 
adjacent to the name of the standard menu item, so as 
to be clearly associated with the standard menu item, 
on the menu board, including a drive-through menu board, 
the number of calories contained in the standard menu 
item, as usually prepared and offered for sale; and 
‘‘(bb) a succinct statement concerning suggested daily 
caloric intake, as specified by the Secretary by regulation 
and posted prominently on the menu board, designed to 
enable the public to understand, in the context of a total 
daily diet, the significance of the nutrition information 
that is provided on the menu board; 
‘‘(III) in a written form, available on the premises of the 
restaurant or similar retail establishment and to the consumer 
upon request, the nutrition information required under clauses 
(C) and (D) of subparagraph (1); and 
‘‘(IV) on the menu or menu board, a prominent, clear, 
and conspicuous statement regarding the availability of the 
information described in item (III). 
‘‘(iii) SELF-SERVICE FOOD AND FOOD ON DISPLAY.—Except 
as provided in subclause (vii), in the case of food sold at a 
salad bar, buffet line, cafeteria line, or similar self-service 
facility, and for self-service beverages or food that is on display 
and that is visible to customers, a restaurant or similar retail 
food establishment shall place adjacent to each food offered 
a sign that lists calories per displayed food item or per serving. 
‘‘(iv) REASONABLE BASIS.—For the purposes of this clause, 
a restaurant or similar retail food establishment shall have 
a reasonable basis for its nutrient content disclosures, including 
nutrient databases, cookbooks, laboratory analyses, and other 
reasonable means, as described in section 101.10 of title 21, 
Code of Federal Regulations (or any successor regulation) or 
in a related guidance of the Food and Drug Administration. 
‘‘(v) MENU VARIABILITY AND COMBINATION MEALS.—The Sec-
retary shall establish by regulation standards for determining 
and disclosing the nutrient content for standard menu items 
that come in different flavors, varieties, or combinations, but 
which are listed as a single menu item, such as soft drinks, 
ice cream, pizza, doughnuts, or children’s combination meals, 
through means determined by the Secretary, including ranges, 
averages, or other methods. 
‘‘(vi) ADDITIONAL
INFORMATION.—If the Secretary deter-
mines that a nutrient, other than a nutrient required under 
subclause (ii)(III), should be disclosed for the purpose of pro-
viding information to assist consumers in maintaining healthy 
dietary practices, the Secretary may require, by regulation, 
disclosure of such nutrient in the written form required under 
subclause (ii)(III). 
‘‘(vii) NONAPPLICABILITY TO CERTAIN FOOD.—