H. R. 3590—881 
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 implementation date of the 
prospective payment system under section 1834(o), under 
such section (calculated 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 sentence: 
‘‘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 reopening 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 indirect 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 adding 
at the end the following: 
‘‘SEC. 5606. STATE GRANTS TO HEALTH CARE PROVIDERS WHO PRO-
VIDE SERVICES TO A HIGH PERCENTAGE 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 determined by such 
State, of medically underserved populations or other special popu-
lations in such State. 
‘‘(b) SOURCE OF FUNDS.—A grant program established by a 
State under subsection (a) may not be established within a depart-
ment, 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 administrative 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 following: 
‘‘Subpart I—Medical Training Generally’’; 
and 
(2) by inserting at the end the following:
H. R. 3590—882 
‘‘Subpart II—Training in Underserved 
Communities 
‘‘SEC. 749B. RURAL PHYSICIAN TRAINING GRANTS. 
‘‘(a) IN GENERAL.—The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration, shall 
establish a grant program for the purposes of assisting eligible 
entities in recruiting students most likely to practice medicine 
in underserved rural communities, providing rural-focused training 
and experience, and increasing the number of recent allopathic 
and osteopathic medical school graduates who practice in under-
served 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 medicine accred-
ited by a nationally recognized accrediting 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 training students, 
as determined by the Secretary, who practice medicine in under-
served rural communities; 
‘‘(2) demonstrate that an existing academic program 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 partner-
ships, 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 entity 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 receiving a grant 
under this section shall use the funds made available under 
such grant to establish, improve, 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 entity shall— 
‘‘(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 underserved rural community; 
and 
‘‘(ii) who express a commitment to practice medi-
cine in an underserved rural community.
H. R. 3590—883 
‘‘(3) CURRICULA.—The Program shall require students to 
enroll in didactic coursework and clinical experience particu-
larly applicable to medical practice in underserved rural 
communities, including— 
‘‘(A) clinical rotations in underserved rural commu-
nities, 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 focused 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 experiences in locations with post-
graduate programs offering residency training opportunities in 
underserved rural communities, or in local residency training 
programs 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 partici-
pate in group activities designed 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 receiving a grant 
under this section shall submit an annual report 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 regulation define 
‘underserved rural community’ for purposes of this section. 
‘‘(g) SUPPLEMENT NOT SUPPLANT.—Any eligible entity receiving 
funds under this section shall use such funds to supplement, not 
supplant, any other Federal, State, and local funds that would 
otherwise be expended by such entity to carry out the activities 
described in this section. 
‘‘(h) MAINTENANCE OF EFFORT.—With respect to activities for 
which funds awarded under this section are to be expended, the 
entity shall agree to maintain expenditures of non-Federal amounts 
for such activities at a level that is not less than the level of 
such expenditures maintained by the entity for the fiscal year 
preceding the fiscal year for which the entity receives a grant 
under this section. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated $4,000,000 for each of the fiscal years 2010 
through 2013.’’. 
(m)(1) Section 768 of the Public Health Service Act (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 Administration and in con-
sultation with the Director of the Centers for Disease Control and 
Prevention, shall award grants to, or enter into contracts with, 
eligible entities to provide training to graduate medical residents 
in preventive medicine specialties.
H. R. 3590—884 
‘‘(b) ELIGIBILITY.—To be eligible for a grant or contract under 
subsection (a), an entity shall be— 
‘‘(1) an accredited school of public health or school of medi-
cine or osteopathic medicine; 
‘‘(2) an accredited public or private nonprofit hospital; 
‘‘(3) a State, local, or tribal health department; or 
‘‘(4) a consortium of 2 or more entities described in para-
graphs (1) through (3). 
‘‘(c) USE OF FUNDS.—Amounts received under a grant or con-
tract 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 medicine 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 (including depart-
ments, divisions, or other appropriate units) in preventive 
medicine and public health; or 
‘‘(B) programs that improve clinical teaching in preven-
tive medicine and public health. 
‘‘(d) REPORT.—The Secretary shall submit to the Congress an 
annual report on the program carried out under this section.’’. 
(2) Section 770(a) of the Public Health Service Act (42 
U.S.C. 295e(a)) is amended to read as follows: 
‘‘(a) IN GENERAL.—For the purpose of carrying out this subpart, 
there is authorized to be appropriated $43,000,000 for fiscal year 
2011, and such sums as may be necessary for each of the fiscal 
years 2012 through 2015.’’. 
(n)(1) Subsection (i) of section 331 of the Public Health Service 
Act (42 U.S.C. 254d) of the Public Health Service Act is amended— 
(A) in paragraph (1), by striking ‘‘In carrying out subpart 
III’’ and all that follows through the period and inserting ‘‘In 
carrying out subpart III, the Secretary may, in accordance 
with this subsection, issue waivers to individuals who have 
entered into a contract for obligated service under the Scholar-
ship Program or the Loan Repayment Program under which 
the individuals are authorized to satisfy the requirement of 
obligated service through providing 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’’; 
(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 either— 
‘‘(i) double the period of obligated service that would 
otherwise be required; or