277 
tions, or an equivalent longitudinal ex-
perience. 
‘‘(V) A minimum of 2 months of 
emergency medicine rotations, or an 
equivalent longitudinal experience.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection apply with respect to— 
(A) payments to hospitals under section 
1886(h) of the Social Security Act (42 U.S.C. 
1395ww(h)) for cost reporting periods begin-
ning on or after January 1, 2010; and 
(B) payments to hospitals under section 
1886(d)(5)(B)(v) of such Act (42 U.S.C. 
1395ww(d)(5)(B)(v)) for discharges occurring 
on or after January 1, 2010. 
SEC. 520. HIV/AIDS REDUCTION IN RACIAL AND ETHNIC MI-
NORITY COMMUNITIES. 
(a) EXPANDED FUNDING.—The Secretary, in col-
laboration with the Director of the Office of Minority 
Health, the Director of the Centers for Disease Control 
and Prevention, the Administrator of the Health Re-
sources and Services Administration, and the Adminis-
trator of the Substance Abuse and Mental Health Services 
Administration, shall provide funds and carry out activi-
ties to expand the Minority HIV/AIDS Initiative. 
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(b) USE OF FUNDS.—The additional funds made 
available under this section may be used, through the Mi-
nority AIDS Initiative, to support the following activities: 
(1) Providing technical assistance and infra-
structure support to reduce HIV/AIDS in minority 
populations. 
(2) Increasing minority populations’ access to 
HIV/AIDS prevention and care services. 
(3) Building strong community programs and 
partnerships to address HIV prevention and the 
health care needs of specific racial and ethnic minor-
ity populations. 
(c) PRIORITY INTERVENTIONS.—Within the racial 
and ethnic minority populations referred to in subsection 
(b), priority in conducting intervention services shall be 
given to— 
(1) women; 
(2) youth; 
(3) men who engage in homosexual activity; 
(4) persons who engage in intravenous drug 
abuse; 
(5) homeless individuals; and 
(6) individuals incarcerated or in the penal sys-
tem. 
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(d) AUTHORIZATION OF APPROPRIATIONS.—For car-
rying out this section, there are authorized to be appro-
priated $610,000,0000 for fiscal year 2010 and such sums 
as may be necessary for each of fiscal years 2011 through 
2014. 
SEC. 521. GRANTS FOR RACIAL AND ETHNIC APPROACHES 
TO COMMUNITY HEALTH. 
(a) PURPOSE.—It is the purpose of this section to 
provide for the awarding of grants to assist communities 
in mobilizing and organizing resources in support of effec-
tive and sustainable programs that will reduce or eliminate 
disparities in health and healthcare experienced by racial 
and ethnic minority individuals. 
(b) AUTHORITY TO AWARD GRANTS.—The Sec-
retary, acting through the Centers for Disease Control and 
Prevention, shall award grants to eligible entities to assist 
in designing, implementing, and evaluating culturally and 
linguistically appropriate, science-based and community- 
driven sustainable strategies to eliminate racial and ethnic 
health and healthcare disparities. 
(c) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall— 
(1) represent a coalition— 
(A) whose principal purpose is to develop 
and implement interventions to reduce or elimi-
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nate a health or healthcare disparity in a tar-
geted racial or ethnic minority group in the 
community served by the coalition; and 
(B) that includes— 
(i) members selected from among— 
(I) public health departments; 
(II) community-based organiza-
tions; 
(III) university and research or-
ganizations; 
(IV) American Indian tribal or-
ganizations, national American Indian 
organizations, Indian Health Service, 
or organizations serving Alaska Na-
tives; and 
(V) interested public or private 
healthcare providers or organizations 
as deemed appropriate by the Sec-
retary; and 
(ii) at least 1 member from a commu-
nity-based organization that represents the 
targeted racial or ethnic minority group; 
and 
(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
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formation as the Secretary may require, which shall 
include— 
(A) a description of the targeted racial or 
ethnic populations in the community to be 
served under the grant; 
(B) a description of at least 1 health dis-
parity that exists in the racial or ethnic tar-
geted populations, including health issues such 
as infant mortality, breast and cervical cancer 
screening and management, cardiovascular dis-
ease, diabetes, child and adult immunization 
levels, or other health priority area(s) as des-
ignated by the Secretary; and 
(C) a demonstration of a proven record of 
accomplishment of the coalition members in 
serving and working with the targeted commu-
nity. 
(d) SUSTAINABILITY.—The Secretary shall give pri-
ority to an eligible entity under this section if the entity 
agrees that, with respect to the costs to be incurred by 
the entity in carrying out the activities for which the grant 
was awarded, the entity (and each of the participating 
partners in the coalition represented by the entity) will 
maintain its expenditures of non-Federal funds for such 
activities at a level that is not less than the level of such 
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expenditures during the fiscal year immediately preceding 
the first fiscal year for which the grant is awarded. 
(e) NONDUPLICATION.—Funds provided through this 
grant program should supplement, not supplant, existing 
Federal funding, and the funds should not be used to du-
plicate the activities of the other health disparity grant 
programs in this Act. 
(f) TECHNICAL ASSISTANCE.—The Secretary may, 
either directly or by grant or contract, provide any entity 
that receives a grant under this section with technical and 
other nonfinancial assistance necessary to meet the re-
quirements of this section. 
(g) DISSEMINATION.—The Secretary shall encourage 
and enable grantees to share best practices, evaluation re-
sults, and reports with communities not affiliated with 
grantees using the Internet, conferences, and other perti-
nent information regarding the projects funded by this 
section, including the outreach efforts of the Office of Mi-
nority Health and Health Disparity Elimination and the 
Centers for Disease Control and Prevention. 
(h) ADMINISTRATIVE
BURDENS.—The Secretary 
shall make every effort to minimize duplicative or unneces-
sary administrative burdens on grantees. 
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(i) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out the Public Health Service Act. 
SEC. 522. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 
(a) ELIMINATION OF ISOLATION TEST FOR COST- 
BASED AMBULANCE REIMBURSEMENT.— 
(1) IN
GENERAL.—Section 1834(l)(8) of the 
Social Security Act (42 U.S.C. 1395m(l)(8)) is 
amended— 
(A) in subparagraph (B)— 
(i) by striking ‘‘owned and’’; and 
(ii) by inserting ‘‘(including when 
such services are provided by the entity 
under an arrangement with the hospital)’’ 
after ‘‘hospital’’; and 
(B) by striking the comma at the end of 
subparagraph (B) and all that follows and in-
serting a period. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to services furnished 
on or after January 1, 2010. 
(b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 
TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 
REQUIREMENT.— 
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(1) IN
GENERAL.—Section 1820(c)(2) of the 
Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 
amended— 
(A) in subparagraph (B)(iii), by striking 
‘‘provides not more than’’ and inserting ‘‘sub-
ject to subparagraph (F), provides not more 
than’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 
LIMIT REQUIREMENT.— 
‘‘(i) IN GENERAL.—A State may elect 
to treat a facility, with respect to the des-
ignation of the facility for a cost reporting 
period, as satisfying the requirement of 
subparagraph (B)(iii) relating to a max-
imum number of acute care inpatient beds 
if the facility elects, in accordance with a 
method specified by the Secretary and be-
fore the beginning of the cost reporting pe-
riod, to meet the requirement under clause 
(ii). 
‘‘(ii) ALTERNATE
REQUIREMENT.— 
The requirement under this clause, with 
respect to a facility and a cost reporting 
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period, is that the total number of inpa-
tient bed days described in subparagraph 
(B)(iii) during such period will not exceed 
7,300. For purposes of this subparagraph, 
an individual who is an inpatient in a bed 
in the facility for a single day shall be 
counted as one inpatient bed day. 
‘‘(iii) WITHDRAWAL OF ELECTION.— 
The option described in clause (i) shall not 
apply to a facility for a cost reporting pe-
riod if the facility (for any two consecutive 
cost reporting periods during the previous 
5 cost reporting periods) was treated under 
such option and had a total number of in-
patient bed days for each of such two cost 
reporting periods that exceeded the num-
ber specified in such clause.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to cost reporting peri-
ods beginning on or after the date of the enactment 
of this Act. 
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286 
SEC. 523. COVERAGE OF MARRIAGE AND FAMILY THERA-
PIST SERVICES AND MENTAL HEALTH COUN-
SELOR SERVICES UNDER PART B OF THE 
MEDICARE PROGRAM. 
(a) COVERAGE OF SERVICES.— 
(1) IN
GENERAL.—Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended— 
(A) in subparagraph (DD), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (EE), by inserting 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(FF) marriage and family therapist services 
(as defined in subsection (ccc)(1)) and mental health 
counselor 
services 
(as 
defined 
in 
subsection 
(hhh)(3));’’. 
(2) DEFINITIONS.—Section 1861 of such Act 
(42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection: 
‘‘Marriage and Family Therapist Services; Marriage and 
Family Therapist; Mental Health Counselor Serv-
ices; Mental Health Counselor 
‘‘(hhh)(1) The term ‘marriage and family therapist 
services’ means services performed by a marriage and 
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family therapist (as defined in paragraph (2)) for the diag-
nosis and treatment of mental illnesses, which the mar-
riage and family therapist is legally authorized to perform 
under State law (or the State regulatory mechanism pro-
vided by State law) of the State in which such services 
are performed, as would otherwise be covered if furnished 
by a physician or as an incident to a physician’s profes-
sional service, but only if no facility or other provider 
charges or is paid any amounts with respect to the fur-
nishing of such services. 
‘‘(2) The term ‘marriage and family therapist’ means 
an individual who— 
‘‘(A) possesses a master’s or doctoral degree 
which qualifies for licensure or certification as a 
marriage and family therapist pursuant to State 
law; 
‘‘(B) after obtaining such degree has performed 
at least 2 years of clinical supervised experience in 
marriage and family therapy; and 
‘‘(C) in the case of an individual performing 
services in a State that provides for licensure or cer-
tification of marriage and family therapists, is li-
censed or certified as a marriage and family thera-
pist in such State. 
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1395k(a)(2)(B)) is amended by adding at the end 
the following new clause: 
‘‘(v) marriage and family therapist 
services and mental health counselor serv-
ices;’’. 
(4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 
of such Act (42 U.S.C. 1395l(a)(1)) is amended— 
(A) by striking ‘‘and (W)’’ and inserting 
‘‘(W)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (X) with respect 
to marriage and family therapist services and 
mental health counselor services under section 
1861(s)(2)(FF), the amounts paid shall be 80 
percent of the lesser of the actual charge for 
the services or 75 percent of the amount deter-
mined for payment of a psychologist under sub-
paragraph (L)’’. 
(5) EXCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPIST SERVICES AND MENTAL HEALTH COUN-
SELOR SERVICES FROM SKILLED NURSING FACILITY 
PROSPECTIVE
PAYMENT
SYSTEM.—Section 
1888(e)(2)(A)(ii) 
of 
such 
Act 
(42 
U.S.C. 
1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar-
riage and family therapist services (as defined in 
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section 1861(hhh)(1)), mental health counselor serv-
ices (as defined in section 1861(hhh)(3)),’’ after 
‘‘qualified psychologist services,’’. 
(6) INCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPISTS AND MENTAL HEALTH COUNSELORS AS 
PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec-
tion 1842(b)(18)(C) of such Act (42 U.S.C. 
1395u(b)(18)(C)) is amended by adding at the end 
the following new clauses: 
‘‘(vii) A marriage and family therapist (as de-
fined in section 1861(hhh)(2)). 
‘‘(viii) A mental health counselor (as defined in 
section 1861(hhh)(4)).’’. 
(b) COVERAGE OF CERTAIN MENTAL HEALTH SERV-
ICES PROVIDED IN CERTAIN SETTINGS.— 
(1) RURAL HEALTH CLINICS AND FEDERALLY 
QUALIFIED
HEALTH
CENTERS.—Section 
1861(aa)(1)(B) of the Social Security Act (42 
U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 
by a clinical social worker (as defined in subsection 
(hh)(1)),’’ and inserting ‘‘, by a clinical social worker 
(as defined in subsection (hh)(1)), by a marriage 
and family therapist (as defined in subsection 
(hhh)(2)), or by a mental health counselor (as de-
fined in subsection (hhh)(4)),’’. 
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(2) 
HOSPICE
PROGRAMS.—Section 
1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 
1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 
one marriage and family therapist (as defined in 
subsection (hhh)(2))’’ after ‘‘social worker’’. 
(c) AUTHORIZATION
OF MARRIAGE
AND FAMILY 
THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST- 
HOSPITAL SERVICES.—Section 1861(ee)(2)(G) of the So-
cial Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended 
by inserting ‘‘marriage and family therapist (as defined 
in subsection (hhh)(2)),’’ after ‘‘social worker,’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to services furnished 
on or after January 1, 2010. 
SEC. 524. ESTABLISHMENT OF RURAL COMMUNITY HOS-
PITAL (RCH) PROGRAM. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x), as amended by section 523, 
is amended by adding at the end of the following new sub-
section: 
‘‘Rural Community Hospital; Rural Community Hospital 
Services 
‘‘(iii)(1) The term ‘rural community hospital’ means 
a hospital (as defined in subsection (e)) that— 
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‘‘(A) is located in a rural area (as defined in 
section 1886(d)(2)(D)) or treated as being so lo-
cated pursuant to section 1886(d)(8)(E); 
‘‘(B) subject to paragraph (2), has less than 51 
acute care inpatient beds, as reported in its most re-
cent cost report; 
‘‘(C) makes available 24-hour emergency care 
services; 
‘‘(D) subject to paragraph (3), has a provider 
agreement in effect with the Secretary and is open 
to the public as of January 1, 2010; and 
‘‘(E) applies to the Secretary for such designa-
tion. 
‘‘(2) For purposes of paragraph (1)(B), beds in a 
psychiatric or rehabilitation unit of the hospital which is 
a distinct part of the hospital shall not be counted. 
‘‘(3) Subparagraph (1)(D) shall not be construed to 
prohibit any of the following from qualifying as a rural 
community hospital: 
‘‘(A) A replacement facility (as defined by the 
Secretary in regulations in effect on January 1, 
2010) with the same service area (as defined by the 
Secretary in regulations in effect on such date). 
‘‘(B) A facility obtaining a new provider num-
ber pursuant to a change of ownership. 
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‘‘(C) A facility which has a binding written 
agreement with an outside, unrelated party for the 
construction, reconstruction, lease, rental, or financ-
ing of a building as of January 1, 2010. 
‘‘(4) Nothing in this subsection shall be construed as 
prohibiting a critical access hospital from qualifying as a 
rural community hospital if the critical access hospital 
meets the conditions otherwise applicable to hospitals 
under subsection (e) and section 1866. 
‘‘(5) Nothing in this subsection shall be construed as 
prohibiting a rural community hospital participating in 
the demonstration program under Section 410A of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173; 117 Stat. 
2313) from qualifying as a rural community hospital if 
the rural community hospital meets the conditions other-
wise applicable to hospitals under subsection (e) and sec-
tion 1866.’’. 
(b) PAYMENT.— 
(1) INPATIENT
HOSPITAL
SERVICES.—Section 
1814 of the Social Security Act (42 U.S.C. 1395f) 
is amended by adding at the end the following new 
subsection: 
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‘‘Payment for Inpatient Services Furnished in Rural 
Community Hospitals 
‘‘(m) The amount of payment under this part for in-
patient hospital services furnished in a rural community 
hospital, other than such services furnished in a psy-
chiatric or rehabilitation unit of the hospital which is a 
distinct part, is, at the election of the hospital in the appli-
cation referred to in section 1861(iii)(1)(E)— 
‘‘(1) 101 percent of the reasonable costs of pro-
viding such services, without regard to the amount 
of the customary or other charge, or 
‘‘(2) the amount of payment provided for under 
the prospective payment system for inpatient hos-
pital services under section 1886(d).’’. 
(2) OUTPATIENT SERVICES.—Section 1834 of 
such Act (42 U.S.C. 1395m) is amended by adding 
at the end the following new subsection: 
‘‘(n) PAYMENT FOR OUTPATIENT SERVICES FUR-
NISHED
IN
RURAL
COMMUNITY
HOSPITALS.—The 
amount of payment under this part for outpatient services 
furnished in a rural community hospital is, at the election 
of the hospital in the application referred to in section 
1861(iii)(1)(E)— 
‘‘(1) 101 percent of the reasonable costs of pro-
viding such services, without regard to the amount 
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(B) innovative approaches to the financing 
and delivery of health services to achieve rural 
health quality goals; and 
(C) development of quality improvement 
support structures to assist rural health sys-
tems and professionals (such as workforce sup-
port structures, quality monitoring and report-
ing, clinical care protocols, and information 
technology applications). 
(2) ELIGIBLE
ENTITIES.—In this subsection, 
the term ‘‘eligible entity’’ means a consortium 
that— 
(A) shall include— 
(i) at least one health care provider or 
health care delivery system located in a 
rural area; and 
(ii) at least one organization rep-
resenting multiple community stakeholders; 
and 
(B) may include other partners such as 
rural research centers. 
(3) CONSULTATION.—In developing the pro-
gram for awarding grants under this subsection, the 
Secretary shall consult with the Administrator of the 
Agency for Healthcare Research and Quality, rural 
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