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1945 of the Social Security Act (as added by section 
2703), in accordance with the payment methodology 
established under subsection (c) of such section; and 
(6) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
(c) REQUIREMENTS FOR HEALTH TEAMS.—A health 
team established pursuant to a grant or contract under sub-
section (a) shall— 
(1) establish contractual agreements with pri-
mary care providers to provide support services; 
(2) support patient-centered medical homes, de-
fined as a mode of care that includes— 
(A) personal physicians; 
(B) whole person orientation; 
(C) coordinated and integrated care; 
(D) safe and high-quality care through evi-
dence-informed medicine, appropriate use of 
health information technology, and continuous 
quality improvements; 
(E) expanded access to care; and 
(F) payment that recognizes added value 
from additional components of patient-centered 
care; 
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(3) collaborate with local primary care providers 
and existing State and community based resources to 
coordinate disease prevention, chronic disease man-
agement, transitioning between health care providers 
and settings and case management for patients, in-
cluding children, with priority given to those ame-
nable to prevention and with chronic diseases or con-
ditions identified by the Secretary; 
(4) in collaboration with local health care pro-
viders, develop and implement interdisciplinary, 
interprofessional care plans that integrate clinical 
and community preventive and health promotion 
services for patients, including children, with a pri-
ority given to those amenable to prevention and with 
chronic diseases or conditions identified by the Sec-
retary; 
(5) incorporate health care providers, patients, 
caregivers, and authorized representatives in program 
design and oversight; 
(6) provide support necessary for local primary 
care providers to— 
(A) coordinate and provide access to high- 
quality health care services; 
(B) coordinate and provide access to pre-
ventive and health promotion services; 
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(C) provide access to appropriate specialty 
care and inpatient services; 
(D) provide quality-driven, cost-effective, 
culturally appropriate, and patient- and family- 
centered health care; 
(E) provide access to pharmacist-delivered 
medication 
management 
services, 
including 
medication reconciliation; 
(F) provide coordination of the appropriate 
use of complementary and alternative (CAM) 
services to those who request such services; 
(G) promote effective strategies for treat-
ment planning, monitoring health outcomes and 
resource use, sharing information, treatment de-
cision support, and organizing care to avoid du-
plication of service and other medical manage-
ment approaches intended to improve quality 
and value of health care services; 
(H) provide local access to the continuum of 
health care services in the most appropriate set-
ting, including access to individuals that imple-
ment the care plans of patients and coordinate 
care, such as integrative health care practi-
tioners; 
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(I) collect and report data that permits 
evaluation of the success of the collaborative ef-
fort on patient outcomes, including collection of 
data on patient experience of care, and identi-
fication of areas for improvement; and 
(J) establish a coordinated system of early 
identification and referral for children at risk 
for developmental or behavioral problems such as 
through the use of infolines, health information 
technology, or other means as determined by the 
Secretary; 
(7) provide 24-hour care management and sup-
port during transitions in care settings including— 
(A) a transitional care program that pro-
vides onsite visits from the care coordinator, as-
sists with the development of discharge plans and 
medication reconciliation upon admission to and 
discharge from the hospitals, nursing home, or 
other institution setting; 
(B) discharge planning and counseling sup-
port to providers, patients, caregivers, and au-
thorized representatives; 
(C) assuring that post-discharge care plans 
include medication management, as appropriate; 
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(D) referrals for mental and behavioral 
health services, which may include the use of 
infolines; and 
(E) transitional health care needs from ado-
lescence to adulthood; 
(8) serve as a liaison to community prevention 
and treatment programs; 
(9) demonstrate a capacity to implement and 
maintain health information technology that meets 
the requirements of certified EHR technology (as de-
fined in section 3000 of the Public Health Service Act 
(42 U.S.C. 300jj)) to facilitate coordination among 
members of the applicable care team and affiliated 
primary care practices; and 
(10) where applicable, report to the Secretary in-
formation on quality measures used under section 
399JJ of the Public Health Service Act. 
(d) REQUIREMENT FOR PRIMARY CARE PROVIDERS.— 
A provider who contracts with a care team shall— 
(1) provide a care plan to the care team for each 
patient participant; 
(2) provide access to participant health records; 
and 
(3) meet regularly with the care team to ensure 
integration of care. 
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(e) REPORTING TO SECRETARY.—An entity that re-
ceives a grant or contract under subsection (a) shall submit 
to the Secretary a report that describes and evaluates, as 
requested by the Secretary, the activities carried out by the 
entity under subsection (c). 
(f) DEFINITION OF PRIMARY CARE.—In this section, 
the term ‘‘primary care’’ means the provision of integrated, 
accessible health care services by clinicians who are ac-
countable for addressing a large majority of personal health 
care needs, developing a sustained partnership with pa-
tients, and practicing in the context of family and commu-
nity. 
SEC. 3503. MEDICATION MANAGEMENT SERVICES IN TREAT-
MENT OF CHRONIC DISEASE. 
Title IX of the Public Health Service Act (42 U.S.C. 
299 et seq.), as amended by section 3501, is further amend-
ed by inserting after section 934 the following: 
‘‘SEC. 935. GRANTS OR CONTRACTS TO IMPLEMENT MEDICA-
TION MANAGEMENT SERVICES IN TREAT-
MENT OF CHRONIC DISEASES. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Patient Safety Research Center established in section 933 
(referred to in this section as the ‘Center’), shall establish 
a program to provide grants or contracts to eligible entities 
to implement medication management (referred to in this 
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section as ‘MTM’) services provided by licensed phar-
macists, as a collaborative, multidisciplinary, inter-profes-
sional approach to the treatment of chronic diseases for tar-
geted individuals, to improve the quality of care and reduce 
overall cost in the treatment of such diseases. The Secretary 
shall commence the program under this section not later 
than May 1, 2010. 
‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant or contract under subsection (a), an entity shall— 
‘‘(1) provide a setting appropriate for MTM 
services, as recommended by the experts described in 
subsection (e); 
‘‘(2) submit to the Secretary a plan for achieving 
long-term financial sustainability; 
‘‘(3) where applicable, submit a plan for coordi-
nating MTM services through local community health 
teams established in section 3502 of the Patient Pro-
tection and Affordable Care Act or in collaboration 
with primary care extension programs established in 
section 399W; 
‘‘(4) submit a plan for meeting the requirements 
under subsection (c); and 
‘‘(5) submit to the Secretary such other informa-
tion as the Secretary may require. 
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‘‘(c) MTM SERVICES TO TARGETED INDIVIDUALS.— 
The MTM services provided with the assistance of a grant 
or contract awarded under subsection (a) shall, as allowed 
by State law including applicable collaborative pharmacy 
practice agreements, include— 
‘‘(1) performing or obtaining necessary assess-
ments of the health and functional status of each pa-
tient receiving such MTM services; 
‘‘(2) formulating a medication treatment plan 
according to therapeutic goals agreed upon by the 
prescriber and the patient or caregiver or authorized 
representative of the patient; 
‘‘(3) selecting, initiating, modifying, recom-
mending changes to, or administering medication 
therapy; 
‘‘(4) monitoring, which may include access to, 
ordering, or performing laboratory assessments, and 
evaluating the response of the patient to therapy, in-
cluding safety and effectiveness; 
‘‘(5) performing an initial comprehensive medi-
cation review to identify, resolve, and prevent medica-
tion-related problems, including adverse drug events, 
quarterly targeted medication reviews for ongoing 
monitoring, and additional followup interventions on 
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a schedule developed collaboratively with the pre-
scriber; 
‘‘(6) documenting the care delivered and commu-
nicating essential information about such care, in-
cluding a summary of the medication review, and the 
recommendations of the pharmacist to other appro-
priate health care providers of the patient in a timely 
fashion; 
‘‘(7) providing education and training designed 
to enhance the understanding and appropriate use of 
the medications by the patient, caregiver, and other 
authorized representative; 
‘‘(8) providing information, support services, 
and resources and strategies designed to enhance pa-
tient adherence with therapeutic regimens; 
‘‘(9) coordinating and integrating MTM services 
within the broader health care management services 
provided to the patient; and 
‘‘(10) such other patient care services allowed 
under pharmacist scopes of practice in use in other 
Federal programs that have implemented MTM serv-
ices. 
‘‘(d) TARGETED INDIVIDUALS.—MTM services pro-
vided by licensed pharmacists under a grant or contract 
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awarded under subsection (a) shall be offered to targeted 
individuals who— 
‘‘(1) take 4 or more prescribed medications (in-
cluding over-the-counter medications and dietary sup-
plements); 
‘‘(2) take any ‘high risk’ medications; 
‘‘(3) have 2 or more chronic diseases, as identi-
fied by the Secretary; or 
‘‘(4) have undergone a transition of care, or 
other factors, as determined by the Secretary, that are 
likely to create a high risk of medication-related prob-
lems. 
‘‘(e) CONSULTATION WITH EXPERTS.—In designing 
and implementing MTM services provided under grants or 
contracts awarded under subsection (a), the Secretary shall 
consult with Federal, State, private, public-private, and 
academic entities, pharmacy and pharmacist organiza-
tions, health care organizations, consumer advocates, chron-
ic disease groups, and other stakeholders involved with the 
research, dissemination, and implementation of phar-
macist-delivered MTM services, as the Secretary determines 
appropriate. The Secretary, in collaboration with this 
group, shall determine whether it is possible to incorporate 
rapid cycle process improvement concepts in use in other 
Federal programs that have implemented MTM services. 
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‘‘(f) REPORTING TO THE SECRETARY.—An entity that 
receives a grant or contract under subsection (a) shall sub-
mit to the Secretary a report that describes and evaluates, 
as requested by the Secretary, the activities carried out 
under subsection (c), including quality measures endorsed 
by the entity with a contract under section 1890 of the So-
cial Security Act, as determined by the Secretary. 
‘‘(g) EVALUATION AND REPORT.—The Secretary shall 
submit to the relevant committees of Congress a report 
which shall— 
‘‘(1) assess the clinical effectiveness of phar-
macist-provided services under the MTM services pro-
gram, as compared to usual care, including an eval-
uation of whether enrollees maintained better health 
with fewer hospitalizations and emergency room visits 
than similar patients not enrolled in the program; 
‘‘(2) assess changes in overall health care re-
source use by targeted individuals; 
‘‘(3) assess patient and prescriber satisfaction 
with MTM services; 
‘‘(4) assess the impact of patient-cost sharing re-
quirements 
on 
medication 
adherence 
and 
rec-
ommendations for modifications; 
‘‘(5) identify and evaluate other factors that may 
impact clinical and economic outcomes, including de-
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mographic characteristics, clinical characteristics, 
and health services use of the patient, as well as char-
acteristics of the regimen, pharmacy benefit, and 
MTM services provided; and 
‘‘(6) evaluate the extent to which participating 
pharmacists who maintain a dispensing role have a 
conflict of interest in the provision of MTM services, 
and if such conflict is found, provide recommenda-
tions on how such a conflict might be appropriately 
addressed. 
‘‘(h) GRANTS OR CONTRACTS TO FUND DEVELOPMENT 
OF
PERFORMANCE
MEASURES.—The Secretary may, 
through the quality measure development program under 
section 931 of the Public Health Service Act, award grants 
or contracts to eligible entities for the purpose of funding 
the development of performance measures that assess the use 
and effectiveness of medication therapy management serv-
ices.’’. 
SEC. 3504. DESIGN AND IMPLEMENTATION OF REGIONAL-
IZED SYSTEMS FOR EMERGENCY CARE. 
(a) IN GENERAL.—Title XII of the Public Health Serv-
ice Act (42 U.S.C. 300d et seq.) is amended— 
(1) in section 1203— 
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(A) in the section heading, by inserting 
‘‘FOR TRAUMA SYSTEMS’’ after ‘‘GRANTS’’; 
and 
(B) in subsection (a), by striking ‘‘Adminis-
trator of the Health Resources and Services Ad-
ministration’’ and inserting ‘‘Assistant Sec-
retary for Preparedness and Response’’; 
(2) by inserting after section 1203 the following: 
‘‘SEC. 1204. COMPETITIVE GRANTS FOR REGIONALIZED SYS-
TEMS FOR EMERGENCY CARE RESPONSE. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Assistant Secretary for Preparedness and Response, shall 
award not fewer than 4 multiyear contracts or competitive 
grants to eligible entities to support pilot projects that de-
sign, implement, and evaluate innovative models of region-
alized, comprehensive, and accountable emergency care and 
trauma systems. 
‘‘(b) ELIGIBLE ENTITY; REGION.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible enti-
ty’ means— 
‘‘(A) a State or a partnership of 1 or more 
States and 1 or more local governments; or 
‘‘(B) an Indian tribe (as defined in section 
4 of the Indian Health Care Improvement Act) 
or a partnership of 1 or more Indian tribes. 
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‘‘(2) REGION.—The term ‘region’ means an area 
within a State, an area that lies within multiple 
States, or a similar area (such as a multicounty 
area), as determined by the Secretary. 
‘‘(3) EMERGENCY SERVICES.—The term ‘emer-
gency services’ includes acute, prehospital, and trau-
ma care. 
‘‘(c) PILOT PROJECTS.—The Secretary shall award a 
contract or grant under subsection (a) to an eligible entity 
that proposes a pilot project to design, implement, and 
evaluate an emergency medical and trauma system that— 
‘‘(1) coordinates with public health and safety 
services, emergency medical services, medical facili-
ties, trauma centers, and other entities in a region to 
develop an approach to emergency medical and trau-
ma system access throughout the region, including 9– 
1–1 Public Safety Answering Points and emergency 
medical dispatch; 
‘‘(2) includes a mechanism, such as a regional 
medical direction or transport communications sys-
tem, that operates throughout the region to ensure 
that the patient is taken to the medically appropriate 
facility (whether an initial facility or a higher-level 
facility) in a timely fashion; 
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‘‘(3) allows for the tracking of prehospital and 
hospital resources, including inpatient bed capacity, 
emergency department capacity, trauma center capac-
ity, on-call specialist coverage, ambulance diversion 
status, and the coordination of such tracking with re-
gional communications and hospital destination deci-
sions; and 
‘‘(4) 
includes 
a 
consistent 
region-wide 
prehospital, hospital, and interfacility data manage-
ment system that— 
‘‘(A) submits data to the National EMS In-
formation System, the National Trauma Data 
Bank, and others; 
‘‘(B) reports data to appropriate Federal 
and State databanks and registries; and 
‘‘(C) contains information sufficient to 
evaluate key elements of prehospital care, hos-
pital destination decisions, including initial hos-
pital and interfacility decisions, and relevant 
health outcomes of hospital care. 
‘‘(d) APPLICATION.— 
‘‘(1) IN GENERAL.—An eligible entity that seeks 
a contract or grant described in subsection (a) shall 
submit to the Secretary an application at such time 
and in such manner as the Secretary may require. 
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‘‘(2) APPLICATION INFORMATION.—Each appli-
cation shall include— 
‘‘(A) an assurance from the eligible entity 
that the proposed system— 
‘‘(i) has been coordinated with the ap-
plicable State Office of Emergency Medical 
Services (or equivalent State office); 
‘‘(ii) includes consistent indirect and 
direct medical oversight of prehospital, hos-
pital, and interfacility transport throughout 
the region; 
‘‘(iii) coordinates prehospital treat-
ment and triage, hospital destination, and 
interfacility transport throughout the re-
gion; 
‘‘(iv) includes a categorization or des-
ignation system for special medical facili-
ties throughout the region that is integrated 
with transport and destination protocols; 
‘‘(v) includes a regional medical direc-
tion, patient tracking, and resource alloca-
tion system that supports day-to-day emer-
gency care and surge capacity and is inte-
grated with other components of the na-
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