230 
(2) such sums as may be necessary for fiscal 
years 2011 through 2014. 
SEC. 424. ADDITIONAL RESEARCH ON THE RELATIONSHIP 
BETWEEN THE BUILT ENVIRONMENT AND 
THE HEALTH OF COMMUNITY RESIDENTS. 
(a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 
section, the term ‘‘eligible institution’’ means a public or 
private nonprofit institution that submits to the Secretary 
of Health and Human Services (in this section referred 
to as the ‘‘Secretary’’) and the Administrator of the Envi-
ronmental Protection Agency (in this section referred to 
as the ‘‘Administrator’’) an application for a grant under 
the grant program authorized under subsection (b)(2) at 
such time, in such manner, and containing such agree-
ments, assurances, and information as the Secretary and 
Administrator may require. 
(b) RESEARCH GRANT PROGRAM.— 
(1) DEFINITION OF HEALTH.—In this section, 
the term ‘‘health’’ includes— 
(A) levels of physical activity; 
(B) consumption of nutritional foods; 
(C) rates of crime; 
(D) air, water, and soil quality; 
(E) risk of injury; 
(F) accessibility to healthcare services; and 
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(G) other indicators as determined appro-
priate by the Secretary. 
(2) GRANTS.—The Secretary, in collaboration 
with the Administrator, shall provide grants to eligi-
ble institutions to conduct and coordinate research 
on the built environment and its influence on indi-
vidual and population-based health. 
(3) RESEARCH.—The Secretary shall support 
research that— 
(A) investigates and defines the causal 
links between all aspects of the built environ-
ment and the health of residents; 
(B) examines— 
(i) the extent of the impact of the 
built environment (including the various 
characteristics of the built environment) on 
the health of residents; 
(ii) the variance in the health of resi-
dents by— 
(I) location (such as inner cities, 
inner suburbs, and outer suburbs); 
and 
(II) population subgroup (such as 
children, the elderly, the disadvan-
taged); or 
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(iii) the importance of the built envi-
ronment to the total health of residents, 
which is the primary variable of interest 
from a public health perspective; 
(C) is used to develop— 
(i) measures to address health and the 
connection of health to the built environ-
ment; and 
(ii) efforts to link the measures to 
travel and health databases; and 
(D) distinguishes carefully between per-
sonal attitudes and choices and external influ-
ences on observed behavior to determine how 
much an observed association between the built 
environment and the health of residents, versus 
the lifestyle preferences of the people that 
choose to live in the neighborhood, reflects the 
physical characteristics of the neighborhood; 
and 
(E)(i) identifies or develops effective inter-
vention strategies to promote better health 
among residents with a focus on behavioral 
interventions and enhancements of the built en-
vironment that promote increased use by resi-
dents; and 
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(ii) in developing the intervention strate-
gies under clause (i), ensures that the interven-
tion strategies will reach out to high-risk popu-
lations, including racial and ethnic minorities 
and low-income urban and rural communities. 
(4) PRIORITY.—In providing assistance under 
the grant program authorized under paragraph (2), 
the Secretary and the Administrator shall give pri-
ority to research that incorporates— 
(A) minority-serving institutions as grant-
ees; 
(B) interdisciplinary approaches; or 
(C) the expertise of the public health, 
physical activity, urban planning, and transpor-
tation research communities in the United 
States and abroad. 
TITLE V—IMPROVEMENT OF 
HEALTH CARE SERVICES 
Subtitle A—Health Empowerment 
Zones 
SEC. 501. SHORT TITLE. 
This subtitle may be cited as the ‘‘Health Empower-
ment Zone Act of 2009’’. 
SEC. 502. FINDINGS. 
The Congress finds the following: 
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(1) Numerous studies and reports, including 
the National Healthcare Disparities Report and Un-
equal Treatment, the 2002 Institute of Medicine Re-
port, document the extensiveness to which health 
disparities exist across the country. 
(2) These studies have found that, on average, 
racial and ethnic minorities are disproportionately 
afflicted with chronic and acute conditions—such as 
cancer, diabetes, and hypertension—and suffer 
worse health outcomes, worse health status, and 
higher mortality rates than their White counter-
parts. 
(3) Several recent studies also show that health 
disparities are a function of not only access to health 
care, but also the social determinants of health—in-
cluding the environment, the physical structure of 
communities, nutrition and food options, educational 
attainment, employment, race, ethnicity, geography, 
and language preference—that directly and indi-
rectly affect the health, health care, and wellness of 
individuals and communities. 
(4) Integrally involving and fully supporting the 
communities most affected by health inequities in 
the assessment, planning, launch, and evaluation of 
health disparity elimination efforts is among the 
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leading recommendations made to adequately ad-
dress and ultimately reduce health disparities. 
(5) Recommendations also include supporting 
the efforts of community stakeholders from a broad 
cross-section—including, but not limited to local 
businesses, local departments of commerce, edu-
cation, labor, urban planning, and transportation, 
and community-based and other nonprofit organiza-
tions—to find areas of common ground around 
health disparity elimination and collaborate to im-
prove the overall health and wellness of a community 
and its residents. 
SEC. 
503. 
DESIGNATION 
OF 
HEALTH 
EMPOWERMENT 
ZONES. 
(a) IN GENERAL.—At the request of an eligible com-
munity partnership, the Secretary may designate an eligi-
ble area as a health empowerment zone. 
(b) ELIGIBILITY CRITERIA.— 
(1) ELIGIBLE
COMMUNITY
PARTNERSHIP.—A 
community partnership is eligible to submit a re-
quest under this section if the partnership— 
(A) demonstrates widespread public sup-
port from key individuals and entities in the eli-
gible area, including State and local govern-
ments, nonprofit organizations, and community 
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and industry leaders, for designation of the eli-
gible area as a health empowerment zone; and 
(B) includes representatives of— 
(i) a broad cross section of stake-
holders and residents from communities in 
the eligible area experiencing dispropor-
tionate disparities in health status and 
health care; and 
(ii) organizations, facilities, and insti-
tutions that have a history of working 
within and serving such communities. 
(2) ELIGIBLE AREA.—An area is eligible to be 
designated as a health empowerment zone under this 
section if one or more communities in the area expe-
rience disproportionate disparities in health status 
and health care. In determining whether a commu-
nity experiences such disparities, the Secretary shall 
consider the data collected by the Department of 
Health and Human Services focusing on the fol-
lowing areas: 
(A) Access to high-quality health services. 
(B) Arthritis, osteoporosis, and chronic 
back conditions. 
(C) Cancer. 
(D) Chronic kidney disease. 
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(E) Diabetes. 
(F) Injury and violence prevention. 
(G) Maternal, infant, and child health. 
(H) Medical product safety. 
(I) Mental health and mental disorders. 
(J) Nutrition and overweight. 
(K) Disability and secondary conditions. 
(L) Educational and community-based 
health programs. 
(M) Environmental health. 
(N) Family planning. 
(O) Food safety. 
(P) Health communication. 
(Q) Health disease and stroke. 
(R) HIV/AIDS. 
(S) Immunization and infectious diseases. 
(T) Occupational safety and health. 
(U) Oral health. 
(V) Physical activity and fitness. 
(W) Public health infrastructure. 
(X) Respiratory diseases. 
(Y) Sexually transmitted diseases. 
(Z) Substance abuse. 
(AA) Tobacco use. 
(BB) Vision and hearing. 
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(c) PROCEDURE.— 
(1) REQUEST.—A request under subsection (a) 
shall— 
(A) describe the bounds of the area to be 
designated as a health empowerment zone and 
the process used to select those bounds; 
(B) demonstrate that the partnership sub-
mitting the request is an eligible community 
partnership described in subsection (b)(1); 
(C) demonstrate that the area is an eligible 
area described in subsection (b)(2); 
(D) include a comprehensive assessment of 
disparities in health status and health care ex-
perience by one or more communities in the 
area; 
(E) set forth— 
(i) a vision and a set of values for the 
area; and 
(ii) a comprehensive and holistic set of 
goals to be achieved in the area through 
designation as a health empowerment zone; 
and 
(F) include a strategic plan for achieving 
the goals described in subparagraph (E)(ii). 
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(2) APPROVAL.—Not later than 60 days after 
the receipt of a request for designation of an area 
as a health empowerment zone under this section, 
the Secretary shall approve or disapprove the re-
quest. 
(d) MINIMUM NUMBER.—The Secretary— 
(1) shall designate not more than 110 health 
empowerment zones under this section; and 
(2) shall designate at least one health empower-
ment zone in each of the several States, the District 
of Columbia, and each territory or possession of the 
United States. 
SEC. 504. ASSISTANCE TO THOSE SEEKING DESIGNATION. 
At the request of any organization or entity seeking 
to submit a request under section 503(a), the Secretary 
shall provide technical assistance, and may award a grant, 
to assist such organization or entity— 
(1) to form an eligible community partnership 
described in section 503(b)(1); 
(2) to complete a health assessment, including 
an assessment of health disparities under section 
503(c)(1)(D); or 
(3) to prepare and submit a request, including 
a strategic plan, in accordance with section 503. 
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SEC. 505. BENEFITS OF DESIGNATION. 
(a) PRIORITY.—In awarding any competitive grant, 
a Federal official shall give priority to any applicant 
that— 
(1) meets the eligibility criteria for the grant; 
(2) proposes to use the grant for activities in a 
health empowerment zone; and 
(3) demonstrates that such activities will di-
rectly and significantly further the goals of the stra-
tegic plan approved for such zone under section 503. 
(b) GRANTS
FOR INITIAL IMPLEMENTATION
OF 
STRATEGIC PLAN.— 
(1) IN GENERAL.—Upon designating an eligible 
area as a health empowerment zone at the request 
of an eligible community partnership, the Secretary 
shall, subject to the availability of appropriations, 
make a grant to the community partnership for im-
plementation of the strategic plan for such zone. 
(2) GRANT PERIOD.—A grant under paragraph 
(1) for a health empowerment zone shall be for a pe-
riod of 2 years and may be renewed, except that the 
total period of grants under paragraph (1) for such 
zone may not exceed 10 years. 
(3) LIMITATION.—In awarding grants under 
this subsection, the Secretary shall not give less pri-
ority to an applicant or reduce the amount of a 
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Subtitle B—Other Improvements of 
Health Care Services 
CHAPTER 1—IN GENERAL 
SEC. 511. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
Title XXXI of the Public Health Service Act, as 
amended by titles II, III, and IV of this Act, is further 
amended by adding at the end the following: 
‘‘Subtitle 
D—Reconstruction 
and 
Improvement Grants for Public 
Health Care Facilities Serving 
Pacific Islanders and the Insu-
lar Areas 
‘‘SEC. 3151. GRANT SUPPORT FOR QUALITY IMPROVEMENT 
INITIATIVES. 
‘‘(a) IN GENERAL.—The Secretary, in collaboration 
with the Administrator of the Health Resources and Serv-
ices Administration, the Director of the Agency for 
Healthcare Research and Quality, and the Administrator 
of the Centers for Medicare & Medicaid Services, shall 
award grants to eligible entities for the conduct of dem-
onstration projects to improve the quality of and access 
to health care. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
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‘‘(1) be a health center, hospital, health plan, 
health system, community clinic. or other health en-
tity determined appropriate by the Secretary— 
‘‘(A) that, by legal mandate or explicitly 
adopted mission, provides patients with access 
to services regardless of their ability to pay; 
‘‘(B) that provides care or treatment for a 
substantial number of patients who are unin-
sured, are receiving assistance under a State 
program under title XIX of the Social Security 
Act, or are members of vulnerable populations, 
as determined by the Secretary; and 
‘‘(C)(i) with respect to which, not less than 
50 percent of the entity’s patient population is 
made up of racial and ethnic minorities; or 
‘‘(ii) that— 
‘‘(I) serves a disproportionate percent-
age of local, minority racial and ethnic pa-
tients, or that has a patient population, at 
least 50 percent of which is limited English 
proficient; and 
‘‘(II) provides an assurance that 
amounts received under the grant will be 
used only to support quality improvement 
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activities in the racial and ethnic popu-
lation served; and 
‘‘(2) prepare and submit to the Secretary an 
application at such time, in such manner, and con-
taining such information as the Secretary may re-
quire. 
‘‘(c) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to applicants 
under subsection (b)(2) that— 
‘‘(1) demonstrate an intent to operate as part 
of a health care partnership, network, collaborative, 
coalition, or alliance where each member entity con-
tributes to the design, implementation, and evalua-
tion of the proposed intervention; or 
‘‘(2) intend to use funds to carry out system-
wide changes with respect to health care quality im-
provement, including— 
‘‘(A) improved systems for data collection 
and reporting; 
‘‘(B) innovative collaborative or similar 
processes; 
‘‘(C) group programs with behavioral or 
self-management interventions; 
‘‘(D) case management services; 
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‘‘(E) physician or patient reminder sys-
tems; 
‘‘(F) educational interventions; or 
‘‘(G) other activities determined appro-
priate by the Secretary. 
‘‘(d) USE OF FUNDS.—An entity shall use amounts 
received under a grant under subsection (a) to support 
the implementation and evaluation of health care quality 
improvement activities or minority health and health care 
disparity reduction activities that include— 
‘‘(1) with respect to health care systems, activi-
ties relating to improving— 
‘‘(A) patient safety; 
‘‘(B) timeliness of care; 
‘‘(C) effectiveness of care; 
‘‘(D) efficiency of care; 
‘‘(E) patient centeredness; and 
‘‘(F) health information technology; and 
‘‘(2) with respect to patients, activities relating 
to— 
‘‘(A) staying healthy; 
‘‘(B) getting well; 
‘‘(C) living with illness or disability; and 
‘‘(D) coping with end of life issues. 
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‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 
provide financial and other technical assistance to grant-
ees under this section for the development of common data 
systems. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2010 through 2015. 
‘‘SEC. 3152. CENTERS OF EXCELLENCE. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, shall designate centers of excellence at 
public hospitals, and other health systems serving large 
numbers of minority patients, that— 
‘‘(1) 
meet 
the 
requirements 
of 
section 
3151(b)(1); 
‘‘(2) demonstrate excellence in providing care to 
minority populations; and 
‘‘(3) demonstrate excellence in reducing dispari-
ties in health and health care. 
‘‘(b) REQUIREMENTS.—A hospital or health system 
that serves as a Center of Excellence under subsection (a) 
shall— 
‘‘(1) design, implement, and evaluate programs 
and policies relating to the delivery of care in ra-
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cially, ethnically, and linguistically diverse popu-
lations; 
‘‘(2) provide training and technical assistance 
to other hospitals and health systems relating to the 
provision of quality health care to minority popu-
lations; and 
‘‘(3) develop activities for graduate or con-
tinuing medical education that institutionalize a 
focus on cultural competence training for health care 
providers. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2010 through 2015. 
‘‘SEC. 3153. RECONSTRUCTION AND IMPROVEMENT GRANTS 
FOR PUBLIC HEALTH CARE FACILITIES SERV-
ING PACIFIC ISLANDERS AND THE INSULAR 
AREAS. 
‘‘(a) IN GENERAL.—The Secretary shall provide di-
rect financial assistance to designated health care pro-
viders and community health centers in American Samoa, 
Guam, the Commonwealth of the Northern Mariana Is-
lands, the United States Virgin Islands, Puerto Rico, and 
Hawaii for the purposes of reconstructing and improving 
health care facilities and services. 
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‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi-
nancial assistance under subsection (a), an entity shall be 
a public health facility or community health center located 
in American Samoa, Guam, or the Commonwealth of the 
Northern Mariana Islands, the United States Virgin Is-
lands, Puerto Rico, and Hawaii that— 
‘‘(1) is owned or operated by— 
‘‘(A) the government of American Samoa, 
Guam, or the Commonwealth of the Northern 
Mariana Islands, the United States Virgin Is-
lands, Puerto Rico, and Hawaii or a unit of 
local government; or 
‘‘(B) a nonprofit organization; and 
‘‘(2)(A) provides care or treatment for a sub-
stantial number of patients who are uninsured, re-
ceiving assistance under a State program under a 
title XVIII of the Social Security Act, or a State 
program under title XIX of such Act, or who are 
members of a vulnerable population, as determined 
by the Secretary; or 
‘‘(B) serves a disproportionate percentage of 
local, minority racial and ethnic patients. 
‘‘(c) REPORT.—Not later than 180 days after the 
date of enactment of this title and annually thereafter, the 
Secretary shall submit to the Congress and the President 
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a report that includes an assessment of health resources 
and facilities serving populations in American Samoa, 
Guam, and the Commonwealth of the Northern Mariana 
Islands, the United States Virgin Islands, Puerto Rico, 
and Hawaii. In preparing such report, the Secretary 
shall— 
‘‘(1) consult with and obtain information on all 
health care facilities needs from the entities de-
scribed in subsection (b); 
‘‘(2) include all amounts of Federal assistance 
received by each entity in the preceding fiscal year; 
‘‘(3) review the total unmet needs of each juris-
diction for health care facilities, including needs for 
renovation and expansion of existing facilities; and 
‘‘(4) include a strategic plan for addressing the 
needs of each jurisdiction identified in the report. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as necessary 
to carry out this section.’’. 
SEC. 512. MEDICAID PAYMENT FOR CERTAIN ALIENS. 
(a) MEDICAID.—Section 1903(v) of the Social Secu-
rity Act (42 U.S.C. 1396b(v)) is amended by striking 
paragraph (4) and inserting the following: 
‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 
403, and 421 of Public Law 104–193, payment shall be 
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made under this section for care and services that are fur-
nished to individuals, if they who otherwise meet the eligi-
bility requirements for medical assistance under the State 
plan approved under this title (other than the requirement 
of the receipt of aid or assistance under title IV, supple-
mental security income benefits under title XVI, or a State 
supplementary payment), and are— 
‘‘(i) lawfully present in the United States; 
‘‘(ii) children under age 21, including optional 
targeted low-income children described in section 
1905(u)(2)(B); or 
‘‘(iii) pregnant women during pregnancy (and 
during the 60-day period beginning on the last day 
of the pregnancy). 
‘‘(B) No debt shall accrue under an affidavit of sup-
port against any sponsor of such individual on the basis 
of provision of medical assistance and the cost of such as-
sistance shall not be considered as an unreimbursed 
cost.’’. 
(b) SCHIP.—Section 2107(e)(1) of the Social Secu-
rity Act (42 U.S.C. 1397gg(e)(1)) is amended by striking 
subparagraph (H) and inserting the following: 
‘‘(H) Paragraph (4) of section 1903(v) (re-
lating to individuals who, but for sections 
401(a), 403, and 421 of Public Law 104–193 
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would be eligible for medical assistance under 
title XXI).’’. 
(c) CONFORMING AMENDMENT.—Section 1137(f) of 
such Act (42 U.S.C. 1320b–7(f)) is amended by inserting 
‘‘and for medical assistance provided to children and preg-
nant women’’ before the period at the end. 
SEC. 513. MEDICAID PAYMENT PARITY FOR THE TERRI-
TORIES. 
(a) ELIMINATION OF FUNDING LIMITATIONS FOR 
PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE NORTH-
ERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 
(1) IN GENERAL.—Section 1108 of the Social 
Security Act (42 U.S.C. 1308) is amended— 
(A) in subsection (f), in the matter before 
paragraph (1), by striking ‘‘subsection (g)’’ and 
inserting ‘‘subsections (g) and (h)’’; 
(B) in subsection (g)(2), in the matter be-
fore subparagraph (A), by inserting ‘‘and sub-
section (h)’’ after ‘‘paragraph (3)’’; and 
(C) by adding at the end the following new 
subsection: 
‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER-
TO RICO, THE VIRGIN ISLANDS, GUAM, THE NORTHERN 
MARIANA ISLANDS, AND AMERICAN SAMOA.—Subsections 
(f) and (g) shall not apply to Puerto Rico, the Virgin Is-
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lands, Guam, the Northern Mariana Islands, and Amer-
ican Samoa for any fiscal year after fiscal year 2009.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1903(u) of such Act (42 U.S.C. 1396c(u)) is amend-
ed by striking paragraph (4). 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply beginning with fiscal 
year 2010. 
(b) PARITY IN FMAP.— 
(1) IN GENERAL.—Section 1905(b)(2) of such 
Act (42 U.S.C. 1396d(b)(2)) is amended by insert-
ing after ‘‘50 per centum’’ the following: ‘‘(except 
that, beginning with fiscal year 2012, the Federal 
medical assistance percentage for Puerto Rico, the 
Virgin Islands, Guam, the Northern Mariana Is-
lands, and American Samoa shall be the Federal 
medical assistance percentage determined by the 
Secretary in consultation (for the Virgin Islands, 
Guam, the Northern Mariana Islands, and American 
Samoa) with the Secretary of the Interior)’’. 
(2) 
2-FISCAL-YEAR
TRANSITION.—Notwith-
standing any other provision of law, during fiscal 
years 2010 and 2011, the Federal medical assist-
ance percentage established under section 1905(b) of 
the Social Security Act (42 U.S.C. 1396d(b)) for 
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Puerto Rico, the Virgin Islands, Guam, the North-
ern Mariana Islands, and American Samoa shall be 
the highest such Federal medical assistance percent-
age applicable to any of the 50 States or the District 
of Columbia for the fiscal year involved, taking into 
account the application of subsections (a) and (b)(1) 
of 5001 of division B of the American Recovery and 
Reinvestment Act of 2009 (Public Law 111–5) to 
such States and District for calendar quarters dur-
ing such fiscal years for which such subsections 
apply respectively. 
(3) PER CAPITA INCOME DATA.— 
(A) REPORT
TO
CONGRESS.—Not later 
than October 1, 2010, the Secretary of Health 
and Human Services shall submit to Congress 
a report that describes the per capita income 
data used to promulgate the Federal medical 
assistance percentage in the territories and how 
such data differ from the per capita income 
data used to promulgate Federal medical assist-
ance percentages for the 50 States and the Dis-
trict of Columbia. The report should include 
recommendations on how the Federal medical 
assistance percentages can be calculated for the 
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territories to ensure parity with the 50 States 
and the District of Columbia. 
(B) APPLICATION.—Section 1101(a)(8)(B) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1308(a)(8)(B)) is amended— 
(i) by striking ‘‘(other than Puerto 
Rico, the Virgin Islands, and Guam)’’ and 
inserting ‘‘(including Puerto Rico, the Vir-
gin Islands, Guam, the Northern Mariana 
Islands, and American Samoa)’’; and 
(ii) by inserting ‘‘(or, if such satisfac-
tory data are not available in the case of 
the Virgin Islands, Guam, the Northern 
Mariana Islands, or American Samoa, sat-
isfactory data available from the Depart-
ment of the Interior for the same period, 
or if such satisfactory data are not avail-
able in the case of Puerto Rico, satisfac-
tory data available from the government of 
the Commonwealth of Puerto Rico for the 
same period)’’ after ‘‘Department of Com-
merce’’. 
(4) RELATION
TO
AMERICAN
RECOVERY
AND 
REINVESTMENT ACT OF 2009.—For any period and 
territory in which the provisions of this subsection 
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apply to a territory, the provisions of section 
5001(b)(2) of division B of the American Recovery 
and Reinvestment Act of 2009 (Public Law 111–5) 
shall not apply (except as otherwise specifically pro-
vided in paragraph (2)). 
SEC. 514. EXTENSION OF MEDICARE SECONDARY PAYER. 
(a) IN GENERAL.—Section 1862(b)(1)(C) of the So-
cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend-
ed— 
(1) in the last sentence, by inserting ‘‘, and be-
fore January 1, 2010’’ after ‘‘prior to such date)’’; 
and 
(2) by adding at the end the following new sen-
tence: ‘‘Effective for items and services furnished on 
or after January 1, 2010 (with respect to periods 
beginning on or after the date that is 42 months 
prior to such date), clauses (i) and (ii) shall be ap-
plied by substituting ‘42-month’ for ‘12-month’ each 
place it appears in the first sentence.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this subsection shall take effect on the date of enactment 
of this Act. For purposes of determining an individual’s 
status under section 1862(b)(1)(C) of the Social Security 
Act (42 U.S.C. 1395y(b)(1)(C)), as amended by para-
graph (1), an individual who is within the coordinating 
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period as of the date of enactment of this Act shall have 
that period extended to the full 42 months described in 
the last sentence of such section, as added by the amend-
ment made by paragraph (1)(B). 
SEC. 515. BORDER HEALTH GRANTS. 
(a) ELIGIBLE ENTITY DEFINED.—In this section, 
the term ‘‘eligible entity’’ means a State, public institution 
of higher education, local government, tribal government, 
nonprofit health organization, community health center, or 
community clinic receiving assistance under section 330 
of the Public Health Service Act (42 U.S.C. 254b), that 
is located in the border area. 
(b) AUTHORIZATION.—From funds appropriated 
under subsection (f), the Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’), 
acting through the United States members of the United 
States-Mexico Border Health Commission, shall award 
grants to eligible entities to address priorities and rec-
ommendations to improve the health of border area resi-
dents that are established by— 
(1) the United States members of the United 
States-Mexico Border Health Commission; 
(2) the State border health offices; and 
(3) the Secretary. 
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(c) APPLICATION.—An eligible entity that desires a 
grant under subsection (b) shall submit an application to 
the Secretary at such time, in such manner, and con-
taining such information as the Secretary may require. 
(d) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (b) shall use the grant funds 
for— 
(1) programs relating to— 
(A) maternal and child health; 
(B) primary care and preventative health; 
(C) public health and public health infra-
structure; 
(D) health education and promotion; 
(E) oral health; 
(F) mental and behavioral health; 
(G) substance abuse; 
(H) health conditions that have a high 
prevalence in the border area; 
(I) medical and health services research; 
(J) workforce training and development; 
(K) 
community 
health 
workers 
or 
promotoras; 
(L) health care infrastructure problems in 
the border area (including planning and con-
struction grants); 
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(M) health disparities in the border area; 
(N) environmental health; and 
(O) outreach and enrollment services with 
respect to Federal programs (including pro-
grams authorized under titles XIX and XXI of 
the Social Security Act (42 U.S.C. 1396 and 
1397aa)); and 
(2) other programs determined appropriate by 
the Secretary. 
(e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro-
vided to an eligible entity awarded a grant under sub-
section (b) shall be used to supplement and not supplant 
other funds available to the eligible entity to carry out the 
activities described in subsection (d). 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$200,000,000 for fiscal year 2010, and such sums as may 
be necessary for each succeeding fiscal year. 
SEC. 516. CANCER PREVENTION AND TREATMENT DEM-
ONSTRATION FOR ETHNIC AND RACIAL MI-
NORITIES. 
(a) DEMONSTRATION.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’) shall conduct demonstration projects 
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(in this section referred to as ‘‘demonstration 
projects’’) for the purpose of developing models and 
evaluating methods that— 
(A) improve the quality of items and serv-
ices provided to target individuals in order to 
facilitate reduced disparities in early detection 
and treatment of cancer; 
(B) improve clinical outcomes, satisfaction, 
quality of life, and appropriate use of Medicare- 
covered services and referral patterns among 
those target individuals with cancer; 
(C) eliminate disparities in the rate of pre-
ventive cancer screening measures, such as pap 
smears, prostate cancer screenings, and CT 
scans for lung cancer among target individuals; 
and 
(D) promote collaboration with community- 
based organizations to ensure cultural com-
petency of health care professionals and lin-
guistic access for persons with limited English 
proficiency. 
(2) TARGET
INDIVIDUAL
DEFINED.—In this 
section, the term ‘‘target individual’’ means an indi-
vidual of a racial and ethnic minority group, as de-
fined by section 1707 of the Public Health Service 
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