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be disclosed to officers and employees of the So-
cial Security Administration, with respect to 
any taxpayer identified by the Commissioner of 
Social Security— 
‘‘(i) return information for the appli-
cable year from returns with respect to 
wages (as defined in section 3121(a) or 
3401(a)) and payments of retirement in-
come (as described in paragraph (1) of this 
subsection), 
‘‘(ii) unearned income information 
and income information of the taxpayer 
from partnerships, trusts, estates, and sub-
chapter S corporations for the applicable 
year, 
‘‘(iii) if the individual filed an income 
tax return for the applicable year, the fil-
ing status, number of dependents, income 
from farming, and income from self-em-
ployment, on such return, 
‘‘(iv) if the individual is a married in-
dividual filing a separate return for the ap-
plicable year, the social security number (if 
reasonably available) of the spouse on such 
return, 
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‘‘(v) if the individual files a joint re-
turn for the applicable year, the social se-
curity number, unearned income informa-
tion, and income information from partner-
ships, trusts, estates, and subchapter S 
corporations of the individual’s spouse on 
such return, and 
‘‘(vi) such other return information 
relating to the individual (or the individ-
ual’s spouse in the case of a joint return) 
as is prescribed by the Secretary by regula-
tion as might indicate that the individual 
is likely to be ineligible for a low-income 
prescription drug subsidy under section 
1860D–14 of the Social Security Act. 
‘‘(B) APPLICABLE
YEAR.—For the pur-
poses of this paragraph, the term ‘applicable 
year’ means the most recent taxable year for 
which information is available in the Internal 
Revenue Service’s taxpayer information records. 
‘‘(C) RESTRICTION ON INDIVIDUALS FOR 
WHOM DISCLOSURE MAY BE REQUESTED.—The 
Commissioner of Social Security shall request 
information under this paragraph only with re-
spect to— 
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‘‘(i) individuals the Social Security 
Administration has identified, using all 
other reasonably available information, as 
likely to be eligible for a low-income pre-
scription 
drug 
subsidy 
under 
section 
1860D–14 of the Social Security Act and 
who have not applied for such subsidy, and 
‘‘(ii) any individual the Social Security 
Administration has identified as a spouse 
of an individual described in clause (i). 
‘‘(D) RESTRICTION ON USE OF DISCLOSED 
INFORMATION.—Return information disclosed 
under this paragraph may be used only by offi-
cers and employees of the Social Security Ad-
ministration solely for purposes of identifying 
individuals likely to be ineligible for a low-in-
come prescription drug subsidy under section 
1860D–14 of the Social Security Act for use in 
outreach efforts under section 1144 of the So-
cial Security Act.’’. 
(b) SAFEGUARDS.—Paragraph (4) of section 6103(p) 
of such Code is amended— 
(1) by striking ‘‘(19),’’ each place it appears, 
and 
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(2) by striking ‘‘or (17)’’ each place it appears 
and inserting ‘‘(17), or (19)’’. 
(c) CONFORMING AMENDMENT.—Paragraph (3) of 
section 6103(a) of such Code is amended by striking 
‘‘(19),’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to disclosures made after the date 
which is 12 months after the date of the enactment of 
this Act. 
SEC. 
1802. 
COMPARATIVE 
EFFECTIVENESS 
RESEARCH 
TRUST FUND; FINANCING FOR TRUST FUND. 
(a) ESTABLISHMENT OF TRUST FUND.— 
(1) IN GENERAL.—Subchapter A of chapter 98 
of the Internal Revenue Code of 1986 (relating to 
trust fund code) is amended by adding at the end 
the following new section: 
‘‘SEC. 9511. HEALTH CARE COMPARATIVE EFFECTIVENESS 
RESEARCH TRUST FUND. 
‘‘(a) CREATION OF TRUST FUND.—There is estab-
lished in the Treasury of the United States a trust fund 
to be known as the ‘Health Care Comparative Effective-
ness Research Trust Fund’ (hereinafter in this section re-
ferred to as the ‘CERTF’), consisting of such amounts 
as may be appropriated or credited to such Trust Fund 
as provided in this section and section 9602(b). 
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‘‘(b) TRANSFERS TO FUND.— 
‘‘(1) IN GENERAL.—There are hereby appro-
priated to the Trust Fund the following: 
‘‘(A) For fiscal year 2010, $90,000,000. 
‘‘(B) For fiscal year 2011, $100,000,000. 
‘‘(C) For fiscal year 2012, $110,000,000. 
‘‘(D) For each fiscal year beginning with 
fiscal year 2013— 
‘‘(i) an amount equivalent to the net 
revenues received in the Treasury from the 
fees imposed under subchapter B of chap-
ter 34 (relating to fees on health insurance 
and self-insured plans) for such fiscal year; 
and 
‘‘(ii) subject to subsection (c)(2), 
amounts determined by the Secretary of 
Health and Human Services to be equiva-
lent to the fair share per capita amount 
computed under subsection (c)(1) for the 
fiscal year multiplied by the average num-
ber of individuals entitled to benefits under 
part A, or enrolled under part B, of title 
XVIII of the Social Security Act during 
such fiscal year. 
‘‘(2) ADMINISTRATIVE PROVISIONS.— 
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‘‘(A) TRANSFERS
FROM
OTHER
TRUST 
FUNDS.—The amounts appropriated by sub-
paragraphs (A), (B), (C), and (D)(ii) of para-
graph (1) shall be transferred from the Federal 
Hospital Insurance Trust Fund and from the 
Federal 
Supplementary 
Medical 
Insurance 
Trust Fund (established under section 1841 of 
such Act), and from the Medicare Prescription 
Drug Account within such Trust Fund, in pro-
portion (as estimated by the Secretary) to the 
total expenditures during such fiscal year that 
are made under title XVIII of such Act from 
the respective trust fund or account. 
‘‘(B) APPROPRIATIONS NOT SUBJECT TO 
FISCAL YEAR LIMITATION.—The amounts ap-
propriated by paragraph (1) shall not be sub-
ject to any fiscal year limitation. 
‘‘(C) PERIODIC
TRANSFERS, ESTIMATES, 
AND
ADJUSTMENTS.—Except as provided in 
subparagraph (A), the provisions of section 
9601 shall apply to the amounts appropriated 
by paragraph (1). 
‘‘(c) FAIR SHARE PER CAPITA AMOUNT.— 
‘‘(1) COMPUTATION.— 
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creased by the annual percentage in-
crease in the medical care component 
of the consumer price index (United 
States city average) for the 12-month 
period ending with April of the pre-
ceding fiscal year. 
Any amount determined under subclause 
(II) shall be rounded to the nearest penny. 
‘‘(2) LIMITATION ON MEDICARE FUNDING.—In 
no case shall the amount transferred under sub-
section (b)(4)(B) for any fiscal year exceed 
$90,000,000. 
‘‘(d) EXPENDITURES FROM FUND.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
amounts in the CERTF are available, without the 
need for further appropriations and without fiscal 
year limitation, to the Secretary of Health and 
Human Services to carry out section 1181 of the So-
cial Security Act. 
‘‘(2) ALLOCATION FOR COMMISSION.—The fol-
lowing amounts in the CERTF shall be available, 
without the need for further appropriations and 
without fiscal year limitation, to the Commission to 
carry out the activities of the Comparative Effective-
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ness Research Commission established under section 
1181(b) of the Social Security Act: 
‘‘(A) For fiscal year 2010, $7,000,000. 
‘‘(B) For fiscal year 2011, $9,000,000. 
‘‘(C) For each fiscal year beginning with 
2012, 2.6 percent of the total amount appro-
priated to the CERTF under subsection (b) for 
the fiscal year. 
‘‘(e) NET REVENUES.—For purposes of this section, 
the term ‘net revenues’ means the amount estimated by 
the Secretary based on the excess of— 
‘‘(1) the fees received in the Treasury under 
subchapter B of chapter 34, over 
‘‘(2) the decrease in the tax imposed by chapter 
1 resulting from the fees imposed by such sub-
chapter.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for such subchapter A is amended by adding 
at the end thereof the following new item: 
‘‘Sec. 9511. Health Care Comparative Effectiveness Research Trust Fund.’’. 
(b) FINANCING FOR FUND FROM FEES ON INSURED 
AND SELF-INSURED HEALTH PLANS.— 
(1) GENERAL RULE.—Chapter 34 of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new subchapter: 
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‘‘Subchapter B—Insured and Self-Insured 
Health Plans 
‘‘Sec. 4375. Health insurance. 
‘‘Sec. 4376. Self-insured health plans. 
‘‘Sec. 4377. Definitions and special rules. 
‘‘SEC. 4375. HEALTH INSURANCE. 
‘‘(a) IMPOSITION OF FEE.—There is hereby imposed 
on each specified health insurance policy for each policy 
year a fee equal to the fair share per capita amount deter-
mined under section 9511(c)(1) multiplied by the average 
number of lives covered under the policy. 
‘‘(b) LIABILITY FOR FEE.—The fee imposed by sub-
section (a) shall be paid by the issuer of the policy. 
‘‘(c) SPECIFIED HEALTH INSURANCE POLICY.—For 
purposes of this section: 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this section, the term ‘specified health in-
surance policy’ means any accident or health insur-
ance policy issued with respect to individuals resid-
ing in the United States. 
‘‘(2) EXEMPTION FOR CERTAIN POLICIES.—The 
term ‘specified health insurance policy’ does not in-
clude any insurance if substantially all of its cov-
erage is of excepted benefits described in section 
9832(c). 
‘‘(3) TREATMENT OF PREPAID HEALTH COV-
ERAGE ARRANGEMENTS.— 
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‘‘(A) IN GENERAL.—In the case of any ar-
rangement described in subparagraph (B)— 
‘‘(i) such arrangement shall be treated 
as a specified health insurance policy, and 
‘‘(ii) the person referred to in such 
subparagraph shall be treated as the 
issuer. 
‘‘(B) DESCRIPTION OF ARRANGEMENTS.— 
An arrangement is described in this subpara-
graph if under such arrangement fixed pay-
ments or premiums are received as consider-
ation for any person’s agreement to provide or 
arrange for the provision of accident or health 
coverage to residents of the United States, re-
gardless of how such coverage is provided or ar-
ranged to be provided. 
‘‘SEC. 4376. SELF-INSURED HEALTH PLANS. 
‘‘(a) IMPOSITION OF FEE.—In the case of any appli-
cable self-insured health plan for each plan year, there is 
hereby imposed a fee equal to the fair share per capita 
amount determined under section 9511(c)(1) multiplied by 
the average number of lives covered under the plan. 
‘‘(b) LIABILITY FOR FEE.— 
‘‘(1) IN GENERAL.—The fee imposed by sub-
section (a) shall be paid by the plan sponsor. 
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‘‘(2) PLAN SPONSOR.—For purposes of para-
graph (1) the term ‘plan sponsor’ means— 
‘‘(A) the employer in the case of a plan es-
tablished or maintained by a single employer, 
‘‘(B) the employee organization in the case 
of a plan established or maintained by an em-
ployee organization, 
‘‘(C) in the case of— 
‘‘(i) a plan established or maintained 
by 2 or more employers or jointly by 1 or 
more employers and 1 or more employee 
organizations, 
‘‘(ii) a multiple employer welfare ar-
rangement, or 
‘‘(iii) a voluntary employees’ bene-
ficiary association described in section 
501(c)(9), 
the association, committee, joint board of trust-
ees, or other similar group of representatives of 
the parties who establish or maintain the plan, 
or 
‘‘(D) the cooperative or association de-
scribed in subsection (c)(2)(F) in the case of a 
plan established or maintained by such a coop-
erative or association. 
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‘‘(c) APPLICABLE SELF-INSURED HEALTH PLAN.— 
For purposes of this section, the term ‘applicable self-in-
sured health plan’ means any plan for providing accident 
or health coverage if— 
‘‘(1) any portion of such coverage is provided 
other than through an insurance policy, and 
‘‘(2) such plan is established or maintained— 
‘‘(A) by one or more employers for the 
benefit of their employees or former employees, 
‘‘(B) by one or more employee organiza-
tions for the benefit of their members or former 
members, 
‘‘(C) jointly by 1 or more employers and 1 
or more employee organizations for the benefit 
of employees or former employees, 
‘‘(D) by a voluntary employees’ beneficiary 
association described in section 501(c)(9), 
‘‘(E) by any organization described in sec-
tion 501(c)(6), or 
‘‘(F) in the case of a plan not described in 
the preceding subparagraphs, by a multiple em-
ployer welfare arrangement (as defined in sec-
tion 3(40) of Employee Retirement Income Se-
curity Act of 1974), a rural electric cooperative 
(as defined in section 3(40)(B)(iv) of such Act), 
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or a rural telephone cooperative association (as 
defined in section 3(40)(B)(v) of such Act). 
‘‘SEC. 4377. DEFINITIONS AND SPECIAL RULES. 
‘‘(a) DEFINITIONS.—For purposes of this sub-
chapter— 
‘‘(1) ACCIDENT AND HEALTH COVERAGE.—The 
term ‘accident and health coverage’ means any cov-
erage which, if provided by an insurance policy, 
would cause such policy to be a specified health in-
surance policy (as defined in section 4375(c)). 
‘‘(2) INSURANCE POLICY.—The term ‘insurance 
policy’ means any policy or other instrument where-
by a contract of insurance is issued, renewed, or ex-
tended. 
‘‘(3) UNITED
STATES.—The term ‘United 
States’ includes any possession of the United States. 
‘‘(b) TREATMENT OF GOVERNMENTAL ENTITIES.— 
‘‘(1) IN GENERAL.—For purposes of this sub-
chapter— 
‘‘(A) the term ‘person’ includes any gov-
ernmental entity, and 
‘‘(B) notwithstanding any other law or rule 
of law, governmental entities shall not be ex-
empt from the fees imposed by this subchapter 
except as provided in paragraph (2). 
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‘‘(2) TREATMENT OF EXEMPT GOVERNMENTAL 
PROGRAMS.—In the case of an exempt governmental 
program, no fee shall be imposed under section 4375 
or section 4376 on any covered life under such pro-
gram. 
‘‘(3) EXEMPT
GOVERNMENTAL
PROGRAM
DE-
FINED.—For purposes of this subchapter, the term 
‘exempt governmental program’ means— 
‘‘(A) any insurance program established 
under title XVIII of the Social Security Act, 
‘‘(B) the medical assistance program es-
tablished by title XIX or XXI of the Social Se-
curity Act, 
‘‘(C) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to individuals (or 
the spouses and dependents thereof) by reason 
of such individuals being— 
‘‘(i) members of the Armed Forces of 
the United States, or 
‘‘(ii) veterans, and 
‘‘(D) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to members of In-
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dian tribes (as defined in section 4(d) of the In-
dian Health Care Improvement Act). 
‘‘(c) TREATMENT AS TAX.—For purposes of subtitle 
F, the fees imposed by this subchapter shall be treated 
as if they were taxes. 
‘‘(d) NO COVER OVER TO POSSESSIONS.—Notwith-
standing any other provision of law, no amount collected 
under this subchapter shall be covered over to any posses-
sion of the United States.’’. 
(2) CLERICAL AMENDMENTS.— 
(A) Chapter 34 of such Code is amended 
by striking the chapter heading and inserting 
the following: 
‘‘CHAPTER 34—TAXES ON CERTAIN 
INSURANCE POLICIES 
‘‘SUBCHAPTER A. POLICIES ISSUED BY FOREIGN INSURERS 
‘‘SUBCHAPTER B. INSURED AND SELF-INSURED HEALTH PLANS 
‘‘Subchapter A—Policies Issued By Foreign 
Insurers’’. 
(B) The table of chapters for subtitle D of 
such Code is amended by striking the item re-
lating to chapter 34 and inserting the following 
new item: 
‘‘CHAPTER 34—TAXES ON CERTAIN INSURANCE POLICIES’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to policies 
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and plans for portions of policy or plan years begin-
ning on or after October 1, 2012. 
TITLE IX—MISCELLANEOUS 
PROVISIONS 
SEC. 1901. REPEAL OF TRIGGER PROVISION. 
Subtitle A of title VIII of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Pub-
lic Law 108–173) is repealed and the provisions of law 
amended by such subtitle are restored as if such subtitle 
had never been enacted. 
SEC. 1902. REPEAL OF COMPARATIVE COST ADJUSTMENT 
(CCA) PROGRAM. 
Section 1860C–1 of the Social Security Act (42 
U.S.C. 1395w–29), as added by section 241(a) of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173), is repealed. 
SEC. 1903. EXTENSION OF GAINSHARING DEMONSTRATION. 
(a) IN GENERAL.—Subsection (d)(3) of section 5007 
of the Deficit Reduction Act of 2005 (Public Law 109– 
171) is amended by inserting ‘‘(or September 30, 2011, 
in the case of a demonstration project in operation as of 
October 1, 2008)’’ after ‘‘December 31, 2009’’. 
(b) FUNDING.— 
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(1) IN
GENERAL.—Subsection (f)(1) of such 
section is amended by inserting ‘‘and for fiscal year 
2010, $1,600,000,’’ after ‘‘$6,000,000,’’. 
(2) AVAILABILITY.—Subsection (f)(2) of such 
section is amended by striking ‘‘2010’’ and inserting 
‘‘2014 or until expended’’. 
(c) REPORTS.— 
(1) QUALITY
IMPROVEMENT
AND
SAVINGS.— 
Subsection (e)(3) of such section is amended by 
striking ‘‘December 1, 2008’’ and inserting ‘‘March 
31, 2011’’. 
(2) FINAL REPORT.—Subsection (e)(4) of such 
section is amended by striking ‘‘May 1, 2010’’ and 
inserting ‘‘March 31, 2013’’. 
SEC. 1904. GRANTS TO STATES FOR QUALITY HOME VISITA-
TION PROGRAMS FOR FAMILIES WITH YOUNG 
CHILDREN AND FAMILIES EXPECTING CHIL-
DREN. 
Part B of title IV of the Social Security Act (42 
U.S.C. 621–629i) is amended by adding at the end the 
following: 
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‘‘Subpart 3—Support for Quality Home Visitation 
Programs 
‘‘SEC. 440. HOME VISITATION PROGRAMS FOR FAMILIES 
WITH YOUNG CHILDREN AND FAMILIES EX-
PECTING CHILDREN. 
‘‘(a) PURPOSE.—The purpose of this section is to im-
prove the well-being, health, and development of children 
by enabling the establishment and expansion of high qual-
ity programs providing voluntary home visitation for fami-
lies with young children and families expecting children. 
‘‘(b) GRANT APPLICATION.—A State that desires to 
receive a grant under this section shall submit to the Sec-
retary for approval, at such time and in such manner as 
the Secretary may require, an application for the grant 
that includes the following: 
‘‘(1) DESCRIPTION OF HOME VISITATION PRO-
GRAMS.—A description of the high quality programs 
of home visitation for families with young children 
and families expecting children that will be sup-
ported by a grant made to the State under this sec-
tion, the outcomes the programs are intended to 
achieve, and the evidence supporting the effective-
ness of the programs. 
‘‘(2) RESULTS OF NEEDS ASSESSMENT.—The 
results of a statewide needs assessment that de-
scribes— 
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to the amount so reserved as the number of children 
in the Indian tribe whose families have income that 
does not exceed 200 percent of the poverty line bears 
to the total number of children in such Indian tribes 
whose families have income that does not exceed 200 
percent of the poverty line. 
‘‘(2) STATES
AND
TERRITORIES.—From the 
amount appropriated under subsection (m) for a fis-
cal year that remains after making the reservations 
required by subsection (l), the Secretary shall allot 
to each State that is not an Indian tribe and that 
meets the requirement of subsection (d), if applica-
ble, for the fiscal year the amount that bears the 
same ratio to the remainder of the amount so appro-
priated as the number of children in the State whose 
families have income that does not exceed 200 per-
cent of the poverty line bears to the total number of 
children in such States whose families have income 
that does not exceed 200 percent of the poverty line. 
‘‘(3) REALLOTMENTS.—The amount of any al-
lotment to a State under a paragraph of this sub-
section for any fiscal year that the State certifies to 
the Secretary will not be expended by the State pur-
suant to this section shall be available for reallot-
ment using the allotment methodology specified in 
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that paragraph. Any amount so reallotted to a State 
is deemed part of the allotment of the State under 
this subsection. 
‘‘(d) MAINTENANCE OF EFFORT.—Beginning with 
fiscal year 2011, a State meets the requirement of this 
subsection for a fiscal year if the Secretary finds that the 
aggregate expenditures by the State from State and local 
sources for programs of home visitation for families with 
young children and families expecting children for the then 
preceding fiscal year was not less than 100 percent of such 
aggregate expenditures for the then 2nd preceding fiscal 
year. 
‘‘(e) PAYMENT OF GRANT.— 
‘‘(1) IN GENERAL.—The Secretary shall make a 
grant to each State that meets the requirements of 
subsections (b) and (d), if applicable, for a fiscal 
year for which funds are appropriated under sub-
section (m), in an amount equal to the reimbursable 
percentage of the eligible expenditures of the State 
for the fiscal year, but not more than the amount 
allotted to the State under subsection (c) for the fis-
cal year. 
‘‘(2) REIMBURSABLE PERCENTAGE DEFINED.— 
In paragraph (1), the term ‘reimbursable percent-
age’ means, with respect to a fiscal year— 
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‘‘(A) 85 percent, in the case of fiscal year 
2010; 
‘‘(B) 80 percent, in the case of fiscal year 
2011; or 
‘‘(C) 75 percent, in the case of fiscal year 
2012 and any succeeding fiscal year. 
‘‘(f) ELIGIBLE EXPENDITURES.— 
‘‘(1) IN GENERAL.—In this section, the term 
‘eligible expenditures’— 
‘‘(A) means expenditures to provide vol-
untary home visitation for as many families 
with young children (under the age of school 
entry) and families expecting children as prac-
ticable, through the implementation or expan-
sion of high quality home visitation programs 
that— 
‘‘(i) adhere to clear evidence-based 
models of home visitation that have dem-
onstrated positive effects on important pro-
gram-determined child and parenting out-
comes, such as reducing abuse and neglect 
and improving child health and develop-
ment; 
‘‘(ii) employ well-trained and com-
petent staff, maintain high quality super-
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vision, provide for ongoing training and 
professional development, and show strong 
organizational capacity to implement such 
a program; 
‘‘(iii) establish appropriate linkages 
and referrals to other community resources 
and supports; 
‘‘(iv) monitor fidelity of program im-
plementation to ensure that services are 
delivered according to the specified model; 
and 
‘‘(v) provide parents with— 
‘‘(I) knowledge of age-appro-
priate child development in cognitive, 
language, social, emotional, and motor 
domains (including knowledge of sec-
ond language acquisition, in the case 
of English language learners); 
‘‘(II) knowledge of realistic ex-
pectations of age-appropriate child be-
haviors; 
‘‘(III) knowledge of health and 
wellness issues for children and par-
ents; 
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‘‘(IV) modeling, consulting, and 
coaching on parenting practices; 
‘‘(V) skills to interact with their 
child to enhance age-appropriate de-
velopment; 
‘‘(VI) skills to recognize and seek 
help for issues related to health, devel-
opmental delays, and social, emo-
tional, and behavioral skills; and 
‘‘(VII) activities designed to help 
parents become full partners in the 
education of their children; 
‘‘(B) includes expenditures for training, 
technical assistance, and evaluations related to 
the programs; and 
‘‘(C) does not include any expenditure with 
respect to which a State has submitted a claim 
for payment under any other provision of Fed-
eral law. 
‘‘(2) PRIORITY FUNDING FOR PROGRAMS WITH 
STRONGEST EVIDENCE.— 
‘‘(A) IN GENERAL.—The expenditures, de-
scribed in paragraph (1), of a State for a fiscal 
year that are attributable to the cost of pro-
grams that do not adhere to a model of home 
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visitation with the strongest evidence of effec-
tiveness shall not be considered eligible expendi-
tures for the fiscal year to the extent that the 
total of the expenditures exceeds the applicable 
percentage for the fiscal year of the allotment 
of the State under subsection (c) for the fiscal 
year. 
‘‘(B) 
APPLICABLE
PERCENTAGE
DE-
FINED.—In subparagraph (A), the term ‘appli-
cable percentage’ means, with respect to a fiscal 
year— 
‘‘(i) 60 percent for fiscal year 2010; 
‘‘(ii) 55 percent for fiscal year 2011; 
‘‘(iii) 50 percent for fiscal year 2012; 
‘‘(iv) 45 percent for fiscal year 2013; 
or 
‘‘(v) 40 percent for fiscal year 2014. 
‘‘(g) NO USE
OF OTHER FEDERAL FUNDS
FOR 
STATE MATCH.—A State to which a grant is made under 
this section may not expend any Federal funds to meet 
the State share of the cost of an eligible expenditure for 
which the State receives a payment under this section. 
‘‘(h) WAIVER AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary may waive 
or modify the application of any provision of this 
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section, other than subsection (b) or (f), to an In-
dian tribe if the failure to do so would impose an 
undue burden on the Indian tribe. 
‘‘(2) SPECIAL
RULE.—An Indian tribe is 
deemed to meet the requirement of subsection (d) 
for purposes of subsections (c) and (e) if— 
‘‘(A) the Secretary waives the requirement; 
or 
‘‘(B) the Secretary modifies the require-
ment, and the Indian tribe meets the modified 
requirement. 
‘‘(i) STATE REPORTS.—Each State to which a grant 
is made under this section shall submit to the Secretary 
an annual report on the progress made by the State in 
addressing the purposes of this section. Each such report 
shall include a description of— 
‘‘(1) the services delivered by the programs that 
received funds from the grant; 
‘‘(2) the characteristics of each such program, 
including information on the service model used by 
the program and the performance of the program; 
‘‘(3) the characteristics of the providers of serv-
ices through the program, including staff qualifica-
tions, work experience, and demographic characteris-
tics; 
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‘‘(8) The indicators and methods used by States 
to monitor whether the programs are being been im-
plemented as designed. 
‘‘(l) RESERVATIONS OF FUNDS.—From the amounts 
appropriated for a fiscal year under subsection (m), the 
Secretary shall reserve— 
‘‘(1) an amount equal to 5 percent of the 
amounts to pay the cost of the evaluation provided 
for in subsection (j), and the provision to States of 
training and technical assistance, including the dis-
semination of best practices in early childhood home 
visitation; and 
‘‘(2) after making the reservation required by 
paragraph (1), an amount equal to 3 percent of the 
amount so appropriated, to pay for grants to Indian 
tribes under this section. 
‘‘(m) APPROPRIATIONS.—Out of any money in the 
Treasury of the United States not otherwise appropriated, 
there is appropriated to the Secretary to carry out this 
section— 
‘‘(1) $50,000,000 for fiscal year 2010; 
‘‘(2) $100,000,000 for fiscal year 2011; 
‘‘(3) $150,000,000 for fiscal year 2012; 
‘‘(4) $200,000,000 for fiscal year 2013; and 
‘‘(5) $250,000,000 for fiscal year 2014. 
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‘‘(n) INDIAN TRIBES TREATED AS STATES.—In this 
section, paragraphs (4), (5), and (6) of section 431(a) 
shall apply.’’. 
SEC. 1905. IMPROVED COORDINATION AND PROTECTION 
FOR DUAL ELIGIBLES. 
Title XI of the Social Security Act is amended by 
inserting after section 1150 the following new section: 
‘‘IMPROVED COORDINATION AND PROTECTION FOR DUAL 
ELIGIBLES 
‘‘SEC. 1150A. (a) IN GENERAL.—The Secretary shall 
provide, through an identifiable office or program within 
the Centers for Medicare & Medicaid Services, for a fo-
cused effort to provide for improved coordination between 
Medicare and Medicaid and protection in the case of dual 
eligibles (as defined in subsection (g)). The office or pro-
gram shall— 
‘‘(1) review Medicare and Medicaid policies re-
lated to enrollment, benefits, service delivery, pay-
ment, and grievance and appeals processes under 
parts A and B of title XVIII, under the Medicare 
Advantage program under part C of such title, and 
under title XIX; 
‘‘(2) identify areas of such policies where better 
coordination and protection could improve care and 
costs; and 
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‘‘(3) issue guidance to States regarding improv-
ing such coordination and protection. 
‘‘(b) ELEMENTS.—The improved coordination and 
protection under this section shall include efforts— 
‘‘(1) to simplify access of dual eligibles to bene-
fits and services under Medicare and Medicaid; 
‘‘(2) to improve care continuity for dual eligi-
bles and ensure safe and effective care transitions; 
‘‘(3) to harmonize regulatory conflicts between 
Medicare and Medicaid rules with regard to dual eli-
gibles; and 
‘‘(4) to improve total cost and quality perform-
ance under Medicare and Medicaid for dual eligibles. 
‘‘(c) RESPONSIBILITIES.—In carrying out this sec-
tion, the Secretary shall provide for the following: 
‘‘(1) An examination of Medicare and Medicaid 
payment systems to develop strategies to foster more 
integrated and higher quality care. 
‘‘(2) Development of methods to facilitate ac-
cess to post-acute and community-based services and 
to identify actions that could lead to better coordina-
tion of community-based care. 
‘‘(3) A study of enrollment of dual eligibles in 
the Medicare Savings Program (as defined in section 
1144(c)(7)), under Medicaid, and in the low-income 
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subsidy program under section 1860D–14 to identify 
methods to more efficiently and effectively reach and 
enroll dual eligibles. 
‘‘(4) An assessment of communication strate-
gies for dual eligibles to determine whether addi-
tional informational materials or outreach is needed, 
including an assessment of the Medicare website, 1– 
800–MEDICARE, and the Medicare handbook. 
‘‘(5) Research and evaluation of areas where 
service utilization, quality, and access to cost sharing 
protection could be improved and an assessment of 
factors related to enrollee satisfaction with services 
and care delivery. 
‘‘(6) Collection (and making available to the 
public) of data and a database that describe the eli-
gibility, benefit and cost-sharing assistance available 
to dual eligibles by State. 
‘‘(7) Support for coordination of State and Fed-
eral contracting and oversight for dual coordination 
programs supportive of the goals described in sub-
section (b). 
‘‘(8) Support for State Medicaid agencies 
through the provision of technical assistance for 
Medicare and Medicaid coordination initiatives de-
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signed to improve acute and long-term care for dual 
eligibles. 
‘‘(9) Monitoring total combined Medicare and 
Medicaid program costs in serving dual eligibles and 
making recommendations for optimizing total quality 
and cost performance across both programs. 
‘‘(10) Coordination of activities relating to 
Medicare Advantage plans under 1859(b)(6)(B)(ii) 
and Medicaid. 
‘‘(d) REPORTING.—The Office or program shall work 
with relevant State agencies and any appropriate quality 
measurement entities to improve and coordinate reporting 
requirements for Medicare and Medicaid. In addition, the 
Office or program shall seek to minimize duplication in 
reporting requirements, where appropriate, and to identify 
opportunities to combine assessment requirements, where 
appropriate. The Office or program shall seek to identify 
quality metrics and assessment requirements that facili-
tate comparisons of the quality of care received by bene-
ficiaries enrolled in or entitled to benefits under fee-for- 
service Medicare, the Medicare Advantage program, fee- 
for-service Medicaid, and Medicaid managed care, and 
combinations thereof (including integrated Medicare-Med-
icaid programs for dual eligibles). 
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‘‘(e) ENDORSEMENT.—The Secretary shall seek en-
dorsement by the entity with a contract under section 
1890(a) of quality measures and benchmarks developed 
under this section. 
‘‘(f) CONSULTATION WITH STAKEHOLDERS.—The 
Office or program shall consult with relevant stakeholders, 
including dual eligible beneficiaries representatives for 
dual eligible beneficiaries, health plans, providers, and rel-
evant State agencies, in the development of policies related 
to integrated Medicare-Medicaid programs for dual eligi-
bles. 
‘‘(g) PERIODIC REPORTS.—Not later than 1 year 
after the date of the enactment of this section and every 
3 years thereafter the Secretary shall submit to Congress 
a report on progress in activities conducted under this sec-
tion. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) DUAL ELIGIBLE.—The term ‘dual eligible’ 
means an individual who is dually eligible for bene-
fits under title XVIII, and medical assistance under 
title XIX, including such individuals who are eligible 
for benefits under the Medicare Savings Program 
(as defined in section 1144(c)(7)). 
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‘‘(2) MEDICARE; MEDICAID.—The terms ‘Medi-
care’ and ‘Medicaid’ mean the programs under titles 
XVIII and XIX, respectively.’’. 
SEC. 1906. ASSESSMENT OF MEDICARE COST-INTENSIVE 
DISEASES AND CONDITIONS. 
(a) INITIAL ASSESSMENT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall conduct an assessment of the 
diseases and conditions that are the most cost-inten-
sive for the Medicare program and, to the extent 
possible, assess the diseases and conditions that 
could become cost-intensive for Medicare in the fu-
ture. In conducting the assessment, the Secretary 
shall include the input of relevant research agencies, 
including the National Institutes of Health, the 
Agency for Healthcare Research and Quality, the 
Food and Drug Administration, and the Centers for 
Medicare & Medicaid Services. 
(2) REPORT.—Not later than January 1, 2011, 
the Secretary shall transmit a report to the Commit-
tees on Energy and Commerce, Ways and Means, 
and Appropriations of the House of Representatives 
and the Committees on Health, Education, Labor 
and Pensions, Finance, and Appropriations of the 
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Senate on the assessment conducted under para-
graph (1). Such report shall— 
(A) include the assessment of current and 
future trends of cost-intensive diseases and con-
ditions described in such paragraph; 
(B) address whether current research pri-
orities are appropriately addressing current and 
future cost-intensive conditions so identified; 
and 
(C) include recommendations concerning 
research in the Department of Health and 
Human Services that should be funded to im-
prove the prevention, treatment, or cure of such 
cost-intensive diseases and conditions. 
(b) UPDATES OF ASSESSMENT.—Not later than Jan-
uary 1, 2013, and biennially thereafter, the Secretary 
shall— 
(1) review and update the assessment and rec-
ommendations described in subsection (a)(1); and 
(2) submit a report described in subsection 
(a)(2) to the Committees specified in subsection 
(a)(2) on such updated assessment and rec-
ommendations. 
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SEC. 1907. ESTABLISHMENT OF CENTER FOR MEDICARE 
AND MEDICAID INNOVATION WITHIN CMS. 
(a) IN GENERAL.—Title XI of the Social Security Act 
is amended by inserting after section 1115 the following 
new section: 
‘‘CENTER FOR MEDICARE AND MEDICAID INNOVATION 
‘‘SEC. 1115A. (a) CENTER
FOR MEDICARE
AND 
MEDICAID INNOVATION ESTABLISHED.— 
‘‘(1) IN GENERAL.—There is created within the 
Centers for Medicare & Medicaid Services a Center 
for Medicare and Medicaid Innovation (in this sec-
tion referred to as the ‘CMI’) to carry out the duties 
described in this section. The purpose of the CMI is 
to test innovative payment and service delivery mod-
els to improve the coordination, quality, and effi-
ciency of health care services provided to applicable 
individuals defined in paragraph (4)(A). 
‘‘(2) DEADLINE.—The Secretary shall ensure 
that the CMI is carrying out the duties described in 
this section by not later than January 1, 2011. 
‘‘(3) CONSULTATION.—In carrying out the du-
ties under this section, the CMI shall consult rep-
resentatives of relevant Federal agencies, clinical 
and analytical experts with expertise in medicine and 
health care management, and States. The CMI shall 
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use open door forums or other mechanisms to seek 
input from interested parties. 
‘‘(4) DEFINITIONS.—In this section: 
‘‘(A) APPLICABLE INDIVIDUAL.—The term 
‘applicable individual’ means— 
‘‘(i) an individual who is enrolled 
under part B and entitled to benefits 
under part A of title XVIII; 
‘‘(ii) an individual who is eligible for 
medical assistance under title XIX; or 
‘‘(iii) an individual who meets the cri-
teria of both clauses (i) and (ii). 
‘‘(B) APPLICABLE TITLE.—The term ‘ap-
plicable title’ means title XVIII, title XIX, or 
both. 
‘‘(b) TESTING OF MODELS (PHASE I).— 
‘‘(1) IN GENERAL.—The CMI shall test pay-
ment and service delivery models in accordance with 
selection criteria under paragraph (2) to determine 
the effect of applying such models under the applica-
ble title (as defined in subsection (a)(4)(B)) on pro-
gram expenditures under such titles and the quality 
of care received by individuals receiving benefits 
under such title. 
‘‘(2) SELECTION OF MODELS TO BE TESTED.— 
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‘‘(A) IN
GENERAL.—The Secretary shall 
give preference to testing models for which, as 
determined by the Administrator of the Centers 
for Medicare & Medicaid Services and using 
such input from outside the Centers as the Ad-
ministrator determines appropriate, there is evi-
dence that the model addresses a defined popu-
lation for which there are deficits in care lead-
ing to poor clinical outcomes or potentially 
avoidable expenditures. The Administrator shall 
focus on models expected to reduce program 
costs under the applicable title while preserving 
or enhancing the quality of care received by in-
dividuals receiving benefits under such title. 
‘‘(B) 
APPLICATION
TO
OTHER
DEM-
ONSTRATIONS.—The Secretary shall operate the 
demonstration programs under sections 1222 
and 1236 of the Affordable Health Care for 
America Act through the CMI in accordance 
with the rules applicable under this section, in-
cluding those relating to evaluations, termi-
nations, and expansions. 
‘‘(3) BUDGET NEUTRALITY.— 
‘‘(A) INITIAL
PERIOD.—The Secretary 
shall not require, as a condition for testing a 
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model under paragraph (1), that the design of 
such model ensure that such model is budget 
neutral initially with respect to expenditures 
under the applicable title. 
‘‘(B) TERMINATION.—The Secretary shall 
terminate or modify the design and implemen-
tation of a model unless the Secretary deter-
mines (and the Chief Actuary of the Centers for 
Medicare & Medicaid Services, with respect to 
spending under the applicable title, certifies), 
after testing has begun, that the model is ex-
pected to— 
‘‘(i) improve the quality of care (as 
determined by the Administrator of the 
Centers for Medicare & Medicaid Services) 
without increasing spending under such 
title; 
‘‘(ii) reduce spending under such titles 
without reducing the quality of care; or 
‘‘(iii) do both. 
Such termination may occur at any time after 
such testing has begun and before completion of 
the testing. 
‘‘(4) EVALUATION.— 
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‘‘(A) IN
GENERAL.—The Secretary shall 
conduct an evaluation of each model tested 
under this subsection. Such evaluation shall in-
clude an analysis of— 
‘‘(i) the quality of care furnished 
under the model, including through the use 
of patient-level outcomes measures; and 
‘‘(ii) the changes in spending under 
the applicable titles by reason of the 
model. 
The Secretary shall make the results of each 
evaluation under this paragraph available to the 
public in a timely fashion. 
‘‘(B) MEASURE
SELECTION.—To the ex-
tent feasible, the Secretary shall select meas-
ures under this paragraph that reflect national 
priorities for quality improvement and patient- 
centered care consistent with the measures de-
veloped under section 1192(c)(1). 
‘‘(5) TESTING
PERIOD.—In no case shall a 
model be tested under this subsection for more than 
a 7-year period. 
‘‘(c) EXPANSION OF MODELS (PHASE II).—The Sec-
retary may expand the duration and the scope of a model 
that is being tested under subsection (b) (including imple-
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mentation on a nationwide basis), to the extent deter-
mined appropriate by the Secretary, if— 
‘‘(1) the Secretary determines that such expan-
sion is expected— 
‘‘(A) to improve the quality of patient care 
without increasing spending under the applica-
ble titles; 
‘‘(B) to reduce spending under applicable 
titles without reducing the quality of care; or 
‘‘(C) to do both; 
‘‘(2) the Chief Actuary of the Centers for Medi-
care & Medicaid Services certifies that such expan-
sion would reduce (or not result in any increase in) 
net program spending under applicable titles; and 
‘‘(3) the Secretary determines that such expan-
sion would not deny or limit the coverage or provi-
sion of benefits under the applicable title for applica-
ble individuals. 
‘‘(d) IMPLEMENTATION.— 
‘‘(1) WAIVER AUTHORITY.—The Secretary may 
waive such requirements of titles XI and XVIII and 
of sections 1902 and 1903(m) as may be necessary 
solely for purposes of carrying out this section with 
respect to testing models described in subsection (b). 
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‘‘(2) LIMITATIONS ON REVIEW.—There shall be 
no administrative or judicial review under section 
1869, section 1878, or otherwise of— 
‘‘(A) the selection of models for testing or 
expansion under this section; 
‘‘(B) the elements, parameters, scope, and 
duration of such models for testing or dissemi-
nation; 
‘‘(C) the termination or modification of the 
design and implementation of a model under 
subsection (b)(3)(B); and 
‘‘(D) determinations about expansion of 
the duration and scope of a model under sub-
section (c) including the determination that a 
model is not expected to meet criteria described 
in paragraphs (1) or (2) of such subsection. 
‘‘(3) ADMINISTRATION.—Chapter 35 of title 44, 
United States Code, shall not apply to the testing 
and evaluation of models or expansion of such mod-
els under this section. 
‘‘(4) FUNDING FOR TESTING ITEMS AND SERV-
ICES AND ADMINISTRATIVE COSTS.— 
‘‘(A) ADDITIONAL BENEFITS.—There shall 
be available until expended, equally divided 
from the Federal Supplementary Hospital In-
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surance Trust Fund and Federal Supple-
mentary Medical Insurance Trust Fund for 
payments for additional benefits for items and 
services under models tested under subsection 
(b) not otherwise covered under this title and 
applicable to benefits under this title, and for 
researching, designing, implementing, and eval-
uating such models, $350,000,000 for fiscal 
year 2010, $440,000,000 for fiscal year 2011, 
$550,000,000 for fiscal year 2012, and, for a 
subsequent fiscal year, the amount determined 
under this subparagraph for the preceding fis-
cal year increased by the annual percentage 
rate of increase in total expenditures under this 
title for the subsequent fiscal year as estimated 
in the latest available Annual Report of the 
Board of Trustees as described in section 
1841(b)(2). 
‘‘(B) MEDICAID.—For administrative costs 
of the Centers for Medicare & Medicaid Serv-
ices for administering this section with respect 
to title XIX, from any amounts in the Treasury 
not otherwise appropriated there are appro-
priated to the Secretary for the Centers for 
Medicare & Medicaid Services Program Man-
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agement Account $25,000,000 for each fiscal 
year beginning with fiscal year 2010. Amounts 
appropriated under this subparagraph for a fis-
cal year shall be available until expended. 
‘‘(e) REPORT TO CONGRESS.—Beginning in 2012, 
and not less than once every other year thereafter, the 
Secretary shall submit to Congress a report on activities 
under this section. Each such report shall describe the 
payment models tested under subsection (b), including the 
number of individuals described in subsection (a)(4)(A)(i) 
and of individuals described in subsection (a)(4)(A)(ii) 
participating in such models and payments made under 
applicable titles for services on behalf of such individuals, 
any models chosen for expansion under subsection (c), and 
the results from evaluations under subsection (b)(4). In 
addition, each such report shall provide such recommenda-
tions as the Secretary believes are appropriate for legisla-
tive action to facilitate the development and expansion of 
successful payment models.’’. 
(b) MEDICAID CONFORMING AMENDMENT.—Section 
1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), 
as amended by sections 1631(b), 1703(a), 1729, 1753, 
1757(a), and 1759(a), is amended— 
(1) in paragraph (78), by striking ‘‘and’’ at the 
end; 
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(2) in paragraph (79), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (79) the fol-
lowing new paragraph: 
‘‘(80) provide for implementation of the pay-
ment models specified by the Secretary under section 
1115A(c) for implementation on a nationwide basis 
unless the State demonstrates to the satisfaction of 
the Secretary that implementation would not be ad-
ministratively feasible or appropriate to the health 
care delivery system of the State.’’. 
SEC. 1908. APPLICATION OF EMERGENCY SERVICES LAWS. 
Nothing in this Act shall be construed to relieve any 
health care provider from providing emergency services as 
required by State or Federal law, including section 1867 
of the Social Security Act (popularly known as 
‘‘EMTALA’’). 
SEC. 1909. DISREGARD UNDER THE SUPPLEMENTAL SECU-
RITY INCOME PROGRAM OF COMPENSATION 
FOR PARTICIPATION IN CLINICAL TRIALS 
FOR RARE DISEASES OR CONDITIONS. 
(a) INCOME DISREGARD.—Section 1612(b) of the So-
cial Security Act (42 U.S.C. 1382a(b)) is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(24); 
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(2) by striking the period at the end of para-
graph (25) and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(26) The first $2,000 per year received by 
such individual (or such spouse) for participation in 
a clinical trial to test a treatment for a rare disease 
or condition (within the meaning of section 5(b)(2) 
of the Orphan Drug Act (Public Law 97–414)), 
that— 
‘‘(A) has been reviewed and approved by 
an institutional review board that— 
‘‘(i) is established to protect the rights 
and welfare of human subjects partici-
pating in research; and 
‘‘(ii) meet the standards for such bod-
ies set forth in part 46 of title 45, Code of 
Federal Regulations; and 
‘‘(B) meets the standards for protection of 
human subjects for clinical research (as set 
forth in such part).’’. 
(b) RESOURCE DISREGARD.—Section 1613(a) of 
such Act (42 U.S.C. 1382b(a)) is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(15); 
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(2) by striking the period at the end of para-
graph (16) and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (16) the fol-
lowing: 
‘‘(17) the first $2,000 per year received by such 
individual (or such spouse) for participation in a 
clinical trial, as described in section 1612(b)(26).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to benefits payable for calendar 
months beginning after the earlier of— 
(1) the date the Commissioner of Social Secu-
rity promulgates regulations to carry out the amend-
ments; or 
(2) the 180-day period that begins with the 
date of the enactment of this Act. 
DIVISION 
C—PUBLIC 
HEALTH 
AND WORKFORCE DEVELOP-
MENT 
SEC. 2001. TABLE OF CONTENTS; REFERENCES. 
(a) TABLE OF CONTENTS.—The table of contents of 
this division is as follows: 
Sec. 2001. Table of contents; references. 
Sec. 2002. Public Health Investment Fund. 
Sec. 2003. Deficit neutrality. 
TITLE I—COMMUNITY HEALTH CENTERS 
Sec. 2101. Increased funding. 
TITLE II—WORKFORCE 
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Subtitle A—Primary Care Workforce 
PART 1—NATIONAL HEALTH SERVICE CORPS 
Sec. 2201. National Health Service Corps. 
Sec. 2202. Authorizations of appropriations. 
PART 2—PROMOTION OF PRIMARY CARE AND DENTISTRY 
Sec. 2211. Frontline health providers. 
‘‘SUBPART XI—HEALTH PROFESSIONAL NEEDS AREAS 
‘‘Sec. 340H. In general. 
‘‘Sec. 340I. Loan repayments. 
‘‘Sec. 340J. Report. 
‘‘Sec. 340K. Allocation. 
Sec. 2212. Primary care student loan funds. 
Sec. 2213. Training in family medicine, general internal medicine, general pedi-
atrics, geriatrics, and physician assistants. 
Sec. 2214. Training of medical residents in community-based settings. 
Sec. 2215. Training for general, pediatric, and public health dentists and dental 
hygienists. 
Sec. 2216. Authorization of appropriations. 
Sec. 2217. Study on effectiveness of scholarships and loan repayments. 
Subtitle B—Nursing Workforce 
Sec. 2221. Amendments to Public Health Service Act. 
Subtitle C—Public Health Workforce 
Sec. 2231. Public Health Workforce Corps. 
‘‘SUBPART XII—PUBLIC HEALTH WORKFORCE 
‘‘Sec. 340L. Public Health Workforce Corps. 
‘‘Sec. 340M. Public Health Workforce Scholarship Program. 
‘‘Sec. 340N. Public Health Workforce Loan Repayment Program. 
Sec. 2232. Enhancing the public health workforce. 
Sec. 2233. Public health training centers. 
Sec. 2234. Preventive medicine and public health training grant program. 
Sec. 2235. Authorization of appropriations. 
Subtitle D—Adapting Workforce to Evolving Health System Needs 
PART 1—HEALTH PROFESSIONS TRAINING FOR DIVERSITY 
Sec. 2241. Scholarships for disadvantaged students, loan repayments and fel-
lowships regarding faculty positions, and educational assistance 
in the health professions regarding individuals from disadvan-
taged backgrounds. 
Sec. 2242. Nursing workforce diversity grants. 
Sec. 2243. Coordination of diversity and cultural competency programs. 
PART 2—INTERDISCIPLINARY TRAINING PROGRAMS 
Sec. 2251. Cultural and linguistic competency training for health professionals. 
Sec. 2252. Innovations in interdisciplinary care training. 
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PART 3—ADVISORY COMMITTEE ON HEALTH WORKFORCE EVALUATION AND 
ASSESSMENT 
Sec. 2261. Health workforce evaluation and assessment. 
PART 4—HEALTH WORKFORCE ASSESSMENT 
Sec. 2271. Health workforce assessment. 
PART 5—AUTHORIZATION OF APPROPRIATIONS 
Sec. 2281. Authorization of appropriations. 
TITLE III—PREVENTION AND WELLNESS 
Sec. 2301. Prevention and wellness. 
‘‘TITLE XXXI—PREVENTION AND WELLNESS 
‘‘Subtitle A—Prevention and Wellness Trust 
‘‘Sec. 3111. Prevention and Wellness Trust. 
‘‘Subtitle B—National Prevention and Wellness Strategy 
‘‘Sec. 3121. National Prevention and Wellness Strategy. 
‘‘Subtitle C—Prevention Task Forces 
‘‘Sec. 3131. Task Force on Clinical Preventive Services. 
‘‘Sec. 3132. Task Force on Community Preventive Services. 
‘‘Subtitle D—Prevention and Wellness Research 
‘‘Sec. 3141. Prevention and wellness research activity coordination. 
‘‘Sec. 3142. Community prevention and wellness research grants. 
‘‘Sec. 3143. Research on subsidies and rewards to encourage wellness and 
healthy behaviors. 
‘‘Subtitle E—Delivery of Community Prevention and Wellness Services 
‘‘Sec. 3151. Community prevention and wellness services grants. 
‘‘Subtitle F—Core Public Health Infrastructure 
‘‘Sec. 3161. Core public health infrastructure for State, local, and tribal 
health departments. 
‘‘Sec. 3162. Core public health infrastructure and activities for CDC. 
‘‘Subtitle G—General Provisions 
‘‘Sec. 3171. Definitions. 
TITLE IV—QUALITY AND SURVEILLANCE 
Sec. 2401. Implementation of best practices in the delivery of health care. 
Sec. 2402. Assistant Secretary for Health Information. 
Sec. 2403. Authorization of appropriations. 
TITLE V—OTHER PROVISIONS 
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Subtitle A—Drug Discount for Rural and Other Hospitals; 340B Program 
Integrity 
Sec. 2501. Expanded participation in 340B program. 
Sec. 2502. Improvements to 340B program integrity. 
Sec. 2503. Effective date. 
Subtitle B—Programs 
PART 1—GRANTS FOR CLINICS AND CENTERS 
Sec. 2511. School-based health clinics. 
Sec. 2512. Nurse-Managed health centers. 
Sec. 2513. Federally qualified behavioral health centers. 
PART 2—OTHER GRANT PROGRAMS 
Sec. 2521. Comprehensive programs to provide education to nurses and create 
a pipeline to nursing. 
Sec. 2522. Mental and behavioral health training. 
Sec. 2523. Reauthorization of telehealth and telemedicine grant programs. 
Sec. 2524. No child left unimmunized against influenza: demonstration pro-
gram using elementary and secondary schools as influenza vac-
cination centers. 
Sec. 2525. Extension of Wisewoman Program. 
Sec. 2526. Healthy teen initiative to prevent teen pregnancy. 
Sec. 2527. National training initiatives on autism spectrum disorders. 
Sec. 2528. Implementation of medication management services in treatment of 
chronic diseases. 
Sec. 2529. Postpartum depression. 
Sec. 2530. Grants to promote positive health behaviors and outcomes. 
Sec. 2531. Medical liability alternatives. 
Sec. 2532. Infant mortality pilot programs. 
Sec. 2533. Secondary school health sciences training program. 
Sec. 2534. Community-based collaborative care networks. 
Sec. 2535. Community-based overweight and obesity prevention program. 
Sec. 2536. Reducing student-to-school nurse ratios. 
Sec. 2537. Medical-legal partnerships. 
Sec. 2538. Screening, brief intervention, referral, and treatment for mental 
health and substance abuse disorders. 
Sec. 2539. Grants to assist in developing medical schools in federally-designated 
health professional shortage areas. 
PART 3—EMERGENCY CARE-RELATED PROGRAMS 
Sec. 2551. Trauma care centers. 
Sec. 2552. Emergency care coordination. 
Sec. 2553. Pilot programs to improve emergency medical care. 
Sec. 2554. Assisting veterans with military emergency medical training to be-
come State-licensed or certified emergency medical technicians 
(EMTs). 
Sec. 2555. Dental emergency responders: public health and medical response. 
Sec. 2556. Dental emergency responders: homeland security. 
PART 4—PAIN CARE AND MANAGEMENT PROGRAMS 
Sec. 2561. Institute of Medicine Conference on Pain. 
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Sec. 2562. Pain research at National Institutes of Health. 
Sec. 2563. Public awareness campaign on pain management. 
Subtitle C—Food and Drug Administration 
PART 1—IN GENERAL 
Sec. 2571. National medical device registry. 
Sec. 2572. Nutrition labeling of standard menu items at chain restaurants and 
of articles of food sold from vending machines. 
Sec. 2573. Protecting consumer access to generic drugs. 
PART 2—BIOSIMILARS 
Sec. 2575. Licensure pathway for biosimilar biological products. 
Sec. 2576. Fees relating to biosimilar biological products. 
Sec. 2577. Amendments to certain patent provisions. 
Subtitle D—Community Living Assistance Services and Supports 
Sec. 2581. Establishment of national voluntary insurance program for pur-
chasing community living assistance services and support 
(CLASS program). 
‘‘TITLE XXXII—COMMUNITY LIVING ASSISTANCE SERVICES AND 
SUPPORTS 
‘‘Sec. 3201. Purpose. 
‘‘Sec. 3202. Definitions. 
‘‘Sec. 3203. CLASS Independence Benefit Plan. 
‘‘Sec. 3204. Enrollment and disenrollment requirements. 
‘‘Sec. 3205. Benefits. 
‘‘Sec. 3206. CLASS Independence Fund. 
‘‘Sec. 3207. CLASS Independence Advisory Council. 
‘‘Sec. 3208. Regulations; annual report. 
‘‘Sec. 3209. Inspector General’s report. 
Subtitle E—Miscellaneous 
Sec. 2585. States failing to adhere to certain employment obligations. 
Sec. 2586. Health centers under Public Health Service Act; liability protections 
for volunteer practitioners. 
Sec. 2587. Report to Congress on the current state of parasitic diseases that 
have been overlooked among the poorest Americans. 
Sec. 2588. Office of Women’s Health. 
Sec. 2588A. Offices of Minority Health. 
Sec. 2589. Long-Term Care and Family Caregiver Support. 
Sec. 2590. Web site on health care labor market and related educational and 
training opportunities. 
Sec. 2591. Online health workforce training programs. 
Sec. 2592. Access for individuals with disabilities. 
Sec. 2593. Duplicative grant programs. 
Sec. 2594. Diabetes screening collaboration and outreach program. 
Sec. 2595. Improvement of vital statistics collection. 
Sec. 2596. National Health Services Corps demonstration on incentive pay-
ments. 
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(b) REFERENCES.—Except as otherwise specified, 
whenever in this division an amendment is expressed in 
terms of an amendment to a section or other provision, 
the reference shall be considered to be made to a section 
or other provision of the Public Health Service Act (42 
U.S.C. 201 et seq.). 
SEC. 2002. PUBLIC HEALTH INVESTMENT FUND. 
(a) ESTABLISHMENT OF FUNDS.— 
(1) IN
GENERAL.—Subject to section 2003, 
there is hereby established in the Treasury a sepa-
rate account to be known as the ‘‘Public Health In-
vestment Fund’’ (referred to in this section and sec-
tion 2003 as the ‘‘Fund’’). 
(2) FUNDING.— 
(A) There shall be deposited into the 
Fund— 
(i) 
for 
fiscal 
year 
2011, 
$4,600,000,000; 
(ii) 
for 
fiscal 
year 
2012, 
$5,600,000,000; 
(iii) 
for 
fiscal 
year 
2013, 
$6,900,000,000; 
(iv) 
for 
fiscal 
year 
2014, 
$7,800,000,000; and 
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(v) 
for 
fiscal 
year 
2015, 
$9,000,000,000. 
(B) Amounts deposited into the Fund shall 
be derived from general revenues of the Treas-
ury only for the fiscal years set forth in this 
section, and amounts appropriated from the 
Fund shall remain available until expended. 
(b) AUTHORIZATION OF APPROPRIATIONS FROM THE 
FUND.— 
(1) NEW FUNDING.— 
(A) IN
GENERAL.—Subject to section 
2003, amounts in the Fund are authorized to 
be appropriated for carrying out activities 
under designated public health provisions. 
(B) DESIGNATED PROVISIONS.—For pur-
poses of this paragraph, the term ‘‘designated 
public health provisions’’ means the provisions 
for which amounts are authorized to be appro-
priated under section 330(s), 338(c), 338H–1, 
799C, 872, or 3111 of the Public Health Serv-
ice Act, as added by this division. 
(2) BASELINE FUNDING.— 
(A) IN GENERAL.—Amounts in the Fund 
are authorized to be appropriated (as described 
in paragraph (1)) for a fiscal year only if (ex-
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cluding any amounts in or appropriated from 
the Fund) the amounts specified in subpara-
graph (B) for the fiscal year involved are equal 
to or greater than the amounts specified in sub-
paragraph (B) for fiscal year 2008. 
(B) AMOUNTS SPECIFIED.—The amounts 
specified in this subparagraph, with respect to 
a fiscal year, are the amounts appropriated (ex-
cluding any amounts in or appropriated from 
the Fund) for the following: 
(i) Community health centers (includ-
ing funds appropriated under the authority 
of section 330 of the Public Health Service 
Act (42 U.S.C. 254b)). 
(ii) The National Health Service 
Corps Program (including funds appro-
priated under the authority of section 338 
of such Act (42 U.S.C. 254k)). 
(iii) The National Health Service 
Corps Scholarship and Loan Repayment 
Programs (including funds appropriated 
under the authority of section 338H of 
such Act (42 U.S.C. 254q)). 
(iv) Primary care education programs 
(including funds appropriated under the 
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authority of sections 736, 740, 741, and 
747 of such Act (42 U.S.C. 293, 293d, 
and 293k)). 
(v) Sections 761 and 770 of such Act 
(42 U.S.C. 294n and 295e). 
(vi) Nursing workforce development 
(including funds appropriated under the 
authority of title VIII of such Act (42 
U.S.C. 296 et seq.)). 
(vii) The National Center for Health 
Statistics (including funds appropriated 
under the authority of sections 304, 306, 
307, and 308 of such Act (42 U.S.C. 
242b, 242k, 242l, and 242m)). 
(viii) The Agency for Healthcare Re-
search and Quality (including funds made 
available under the authority of title IX of 
such Act (42 U.S.C. 299 et seq.)). 
SEC. 2003. DEFICIT NEUTRALITY. 
(a) AVAILABILITY.—Funds appropriated or made 
available pursuant to sections 330(s), 338(c), 338H–1, 
799C, 872, or 3111 of the Public Health Service Act, as 
added by this division, are only available for the purposes 
set forth in this Act. Appropriations shall not be available 
and are precluded from obligation for any other purpose. 
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(b) ESTIMATION OF BUDGETARY IMPACT.—For the 
purposes of estimating the spending effects of this Act, 
the authorization of appropriations from the Fund, to the 
extent amounts in the Fund are derived from the general 
revenues of the Treasury, shall be treated as new direct 
spending and attributed to this Act. 
(c) BUDGETARY TREATMENT.—For the purposes of 
section 257 of the Balanced Budget and Emergency Def-
icit Control Act of 1985, the Fund, to the extent amounts 
in the Fund are derived from the general revenues of the 
Treasury, and not in excess of amounts subsequently ap-
propriated from the Fund, shall be deemed to be included 
on the list of appropriations referenced under section 
250(c)(17) of that Act. 
TITLE I—COMMUNITY HEALTH 
CENTERS 
SEC. 2101. INCREASED FUNDING. 
Section 330 of the Public Health Service Act (42 
U.S.C. 254b) is amended— 
(1) in subsection (r)(1)— 
(A) in subparagraph (D), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (E), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by inserting at the end the following: 
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‘‘(F) such sums as may be necessary for 
each of fiscal years 2013 through 2015.’’; and 
(2) by inserting after subsection (r) the fol-
lowing: 
‘‘(s) ADDITIONAL FUNDING.—For the purpose of 
carrying out this section, in addition to any other amounts 
authorized to be appropriated for such purpose, there are 
authorized to be appropriated, out of any monies in the 
Public Health Investment Fund, the following: 
‘‘(1) For fiscal year 2011, $1,000,000,000. 
‘‘(2) For fiscal year 2012, $1,500,000,000. 
‘‘(3) For fiscal year 2013, $2,500,000,000. 
‘‘(4) For fiscal year 2014, $3,000,000,000. 
‘‘(5) For fiscal year 2015, $4,000,000,000.’’. 
TITLE II—WORKFORCE 
Subtitle A—Primary Care 
Workforce 
PART 1—NATIONAL HEALTH SERVICE CORPS 
SEC. 2201. NATIONAL HEALTH SERVICE CORPS. 
(a) FULFILLMENT
OF OBLIGATED SERVICE RE-
QUIREMENT THROUGH HALF-TIME SERVICE.— 
(1) WAIVERS.—Subsection (i) of section 331 
(42 U.S.C. 254d) is amended— 
(A) in paragraph (1), by striking ‘‘In car-
rying out subpart III’’ and all that follows 
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through the period and inserting ‘‘In carrying 
out subpart III, the Secretary may, in accord-
ance with this subsection, issue waivers to indi-
viduals who have entered into a contract for ob-
ligated service under the Scholarship Program 
or the Loan Repayment Program under which 
the individuals are authorized to satisfy the re-
quirement of obligated service through pro-
viding 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 
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338C through half-time clinical practice and ei-
ther— 
‘‘(i) double the period of obligated service 
that would otherwise be required; or 
‘‘(ii) in the case of contracts entered into 
under section 338B, accept a minimum service 
obligation of 2 years with an award amount 
equal to 50 percent of the amount that would 
otherwise be payable for full-time service; and’’; 
and 
(C) in paragraph (3), by striking ‘‘In eval-
uating a demonstration project described in 
paragraph (1)’’ and inserting ‘‘In evaluating 
waivers issued under paragraph (1)’’. 
(2) DEFINITIONS.—Subsection (j) of section 
331 (42 U.S.C. 254d) is amended by adding at the 
end the following: 
‘‘(5) The terms ‘full time’ and ‘full-time’ mean 
a minimum of 40 hours per week in a clinical prac-
tice, for a minimum of 45 weeks per year. 
‘‘(6) The terms ‘half time’ and ‘half-time’ mean 
a minimum of 20 hours per week (not to exceed 39 
hours per week) in a clinical practice, for a min-
imum of 45 weeks per year.’’. 
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(b) REAPPOINTMENT TO NATIONAL ADVISORY COUN-
CIL.—Section 337(b)(1) (42 U.S.C. 254j(b)(1)) is amend-
ed by striking ‘‘Members may not be reappointed to the 
Council.’’. 
(c) 
LOAN
REPAYMENT
AMOUNT.—Section 
338B(g)(2)(A) (42 U.S.C. 254l–1(g)(2)(A)) is amended 
by striking ‘‘$35,000’’ and inserting ‘‘$50,000, plus, be-
ginning with fiscal year 2012, an amount determined by 
the Secretary on an annual basis to reflect inflation,’’. 
(d) TREATMENT OF TEACHING AS OBLIGATED SERV-
ICE.—Subsection (a) of section 338C (42 U.S.C. 254m) 
is amended by adding at the end the following: ‘‘The Sec-
retary may treat teaching as clinical practice for up to 
20 percent of such period of obligated service.’’. 
SEC. 2202. AUTHORIZATIONS OF APPROPRIATIONS. 
(a) NATIONAL
HEALTH
SERVICE
CORPS
PRO-
GRAM.—Section 338 (42 U.S.C. 254k) is amended— 
(1) in subsection (a), by striking ‘‘2012’’ and 
inserting ‘‘2015’’; and 
(2) by adding at the end the following: 
‘‘(c) For the purpose of carrying out this subpart, 
in addition to any other amounts authorized to be appro-
priated for such purpose, there are authorized to be appro-
priated, out of any monies in the Public Health Invest-
ment Fund, the following: 
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‘‘(1) $63,000,000 for fiscal year 2011. 
‘‘(2) $66,000,000 for fiscal year 2012. 
‘‘(3) $70,000,000 for fiscal year 2013. 
‘‘(4) $73,000,000 for fiscal year 2014. 
‘‘(5) $77,000,000 for fiscal year 2015.’’. 
(b) SCHOLARSHIP
AND LOAN REPAYMENT PRO-
GRAMS.—Subpart III of part D of title III of the Public 
Health Service Act (42 U.S.C. 254l et seq.) is amended— 
(1) in section 338H(a)— 
(A) in paragraph (4), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (5), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(6) for each of fiscal years 2013 through 
2015, such sums as may be necessary.’’; and 
(2) by inserting after section 338H the fol-
lowing: 
‘‘SEC. 338H–1. ADDITIONAL FUNDING. 
‘‘For the purpose of carrying out this subpart, in ad-
dition to any other amounts authorized to be appropriated 
for such purpose, there are authorized to be appropriated, 
out of any monies in the Public Health Investment Fund, 
the following: 
‘‘(1) $254,000,000 for fiscal year 2011. 
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‘‘(2) $266,000,000 for fiscal year 2012. 
‘‘(3) $278,000,000 for fiscal year 2013. 
‘‘(4) $292,000,000 for fiscal year 2014. 
‘‘(5) $306,000,000 for fiscal year 2015.’’. 
PART 2—PROMOTION OF PRIMARY CARE AND 
DENTISTRY 
SEC. 2211. FRONTLINE HEALTH PROVIDERS. 
Part D of title III (42 U.S.C. 254b et seq.) is amend-
ed by adding at the end the following: 
‘‘Subpart XI—Health Professional Needs Areas 
‘‘SEC. 340H. IN GENERAL. 
‘‘(a) PROGRAM.—The Secretary, acting through the 
Administrator of the Health Resources and Services Ad-
ministration, shall establish a program, to be known as 
the Frontline Health Providers Loan Repayment Pro-
gram, to address unmet health care needs in health profes-
sional needs areas through loan repayments under section 
340I. 
‘‘(b) DESIGNATION
OF
HEALTH
PROFESSIONAL 
NEEDS AREAS.— 
‘‘(1) IN GENERAL.—In this subpart, the term 
‘health professional needs area’ means an area, pop-
ulation, or facility that is designated by the Sec-
retary in accordance with paragraph (2). 
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‘‘(2) DESIGNATION.—To be designated by the 
Secretary as a health professional needs area under 
this subpart: 
‘‘(A) In the case of an area, the area must 
be a rational area for the delivery of health 
services. 
‘‘(B) The area, population, or facility must 
have, in one or more health disciplines, special-
ties, or subspecialties for the population served, 
as determined by the Secretary— 
‘‘(i) insufficient capacity of health 
professionals; or 
‘‘(ii) high needs for health services, in-
cluding services to address health dispari-
ties. 
‘‘(C) With respect to the delivery of pri-
mary health services, the area, population, or 
facility must not include a health professional 
shortage area (as designated under section 
332), except that the area, population, or facil-
ity may include such a health professional 
shortage area in which there is an unmet need 
for such services. 
‘‘(c) ELIGIBILITY.—To be eligible to participate in 
the Program, an individual shall— 
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‘‘(1) hold a degree in a course of study or pro-
gram (approved by the Secretary) from a school de-
fined in section 799B(1)(A) (other than a school of 
public health); 
‘‘(2) hold a degree in a course of study or pro-
gram (approved by the Secretary) from a school or 
program defined in subparagraph (C), (D), or 
(E)(4) of section 799B(1), as designated by the Sec-
retary; 
‘‘(3) be enrolled as a full-time student— 
‘‘(A) in a school or program defined in 
subparagraph (C), (D), or (E)(4) of section 
799B(1), as designated by the Secretary, or a 
school described in paragraph (1); and 
‘‘(B) in the final year of a course of study 
or program, offered by such school or program 
and approved by the Secretary, leading to a de-
gree in a discipline referred to in subparagraph 
(A) (other than a graduate degree in public 
health), (C), (D), or (E)(4) of section 799B(1); 
‘‘(4) be a practitioner described in section 
1842(b)(18)(C) or 1848(k)(3)(B)(iii) or (iv) of the 
Social Security Act; or 
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‘‘(5) be a practitioner in the field of respiratory 
therapy, medical technology, or radiologic tech-
nology. 
‘‘(d) DEFINITIONS.—In this subpart: 
‘‘(1) The term ‘health disparities’ has the 
meaning given to the term in section 3171. 
‘‘(2) The term ‘primary health services’ has the 
meaning given to such term in section 331(a)(3)(D). 
‘‘SEC. 340I. LOAN REPAYMENTS. 
‘‘(a) LOAN REPAYMENTS.—The Secretary, acting 
through the Administrator of the Health Resources and 
Services Administration, shall enter into contracts with in-
dividuals under which— 
‘‘(1) the individual agrees— 
‘‘(A) to serve as a full-time primary health 
services provider or as a full-time or part-time 
provider of other health services for a period of 
time equal to 2 years or such longer period as 
the individual may agree to; 
‘‘(B) to serve in a health professional 
needs area in a health discipline, specialty, or a 
subspecialty for which the area, population, or 
facility is designated as a health professional 
needs area under section 340H; and 
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‘‘(C) in the case of an individual described 
in section 340H(c)(3) who is in the final year 
of study and who has accepted employment as 
a primary health services provider or provider 
of other health services in accordance with sub-
paragraphs (A) and (B), to complete the edu-
cation or training and maintain an acceptable 
level of academic standing (as determined by 
the educational institution offering the course 
of study or training); and 
‘‘(2) the Secretary agrees to pay, for each year 
of such service, an amount on the principal and in-
terest of the undergraduate or graduate educational 
loans (or both) of the individual that is not more 
than 50 percent of the average award made under 
the National Health Service Corps Loan Repayment 
Program under subpart III in that year. 
‘‘(b) PRACTICE SETTING.—A contract entered into 
under this section shall allow the individual receiving the 
loan repayment to satisfy the service requirement de-
scribed in subsection (a)(1) through employment in a solo 
or group practice, a clinic, an accredited public or private 
nonprofit hospital, or any other health care entity, as 
deemed appropriate by the Secretary. 
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‘‘(c) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D shall, except as incon-
sistent with this section, apply to the loan repayment pro-
gram under this subpart in the same manner and to the 
same extent as such provisions apply to the National 
Health Service Corps Loan Repayment Program estab-
lished under section 338B. 
‘‘(d) INSUFFICIENT NUMBER OF APPLICANTS.—If 
there are an insufficient number of applicants for loan re-
payments under this section to obligate all appropriated 
funds, the Secretary shall transfer the unobligated funds 
to the National Health Service Corps for the purpose of 
recruiting applicants and entering into contracts with indi-
viduals so as to ensure a sufficient number of participants 
in the National Health Service Corps for the following 
year. 
‘‘SEC. 340J. REPORT. 
‘‘The Secretary shall submit to the Congress an an-
nual report on the program carried out under this subpart. 
‘‘SEC. 340K. ALLOCATION. 
‘‘Of the amount of funds obligated under this subpart 
each fiscal year for loan repayments— 
‘‘(1) 90 percent shall be for physicians and 
other health professionals providing primary health 
services; and 
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‘‘(2) 10 percent shall be for health professionals 
not described in paragraph (1).’’. 
SEC. 2212. PRIMARY CARE STUDENT LOAN FUNDS. 
(a) IN GENERAL.—Section 735 (42 U.S.C. 292y) is 
amended— 
(1) by redesignating subsection (f) as sub-
section (g); and 
(2) by inserting after subsection (e) the fol-
lowing: 
‘‘(f) DETERMINATION OF FINANCIAL NEED.—The 
Secretary— 
‘‘(1) may require, or authorize a school or other 
entity to require, the submission of financial infor-
mation to determine the financial resources available 
to any individual seeking assistance under this sub-
part; and 
‘‘(2) shall take into account the extent to which 
such individual is financially independent in deter-
mining whether to require or authorize the submis-
sion of such information regarding such individual’s 
family members.’’. 
(b) REVISED GUIDELINES.—The Secretary of Health 
and Human Services shall— 
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participate in the demonstration project under such 
section; 
‘‘(3) be an applicant for designation described 
in paragraph (1) or (2) and have demonstrated to 
the Secretary appropriate involvement of an accred-
ited teaching hospital to carry out the inpatient re-
sponsibilities associated with a primary care resi-
dency training program; or 
‘‘(4) be eligible to be designated as described in 
paragraph (1) or (2), not be an applicant as de-
scribed in paragraph (3), and have demonstrated ap-
propriate involvement of an accredited teaching hos-
pital to carry out the inpatient responsibilities asso-
ciated with a primary care residency training pro-
gram. 
‘‘(d) PREFERENCES.—In awarding grants and con-
tracts under paragraph (1) or (2) of subsection (b), the 
Secretary shall give preference to entities that— 
‘‘(1) support teaching programs that address 
the health care needs of vulnerable populations; or 
‘‘(2) are a Federally qualified health center (as 
defined in section 1861(aa)(4) of the Social Security 
Act) or a rural health clinic (as defined in section 
1861(aa)(2) of such Act). 
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