H. R. 3590—531 
innovative supportive activities to enhance education through dis-
tance learning, continuing educational activities, collaborative con-
ferences, and electronic and telelearning activities, with priority 
for primary care. 
‘‘(e) AUTHORIZATION.—There is authorized to be appropriated 
to carry out this section $5,000,000 for each of the fiscal years 
2010 through 2014, and such sums as may be necessary for each 
subsequent fiscal year.’’. 
SEC. 5404. WORKFORCE DIVERSITY GRANTS. 
Section 821 of the Public Health Service Act (42 U.S.C. 296m) 
is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘The Secretary may’’ and inserting the 
following: 
‘‘(1) AUTHORITY.—The Secretary may’’; 
(B) by striking ‘‘pre-entry preparation, and retention 
activities’’ and inserting the following: ‘‘stipends for diploma 
or associate degree nurses to enter a bridge or degree 
completion program, student scholarships or stipends for 
accelerated nursing degree programs, pre-entry prepara-
tion, advanced education preparation, and retention activi-
ties’’; and 
(2) in subsection (b)— 
(A) by striking ‘‘First’’ and all that follows through 
‘‘including the’’ and inserting ‘‘National Advisory Council 
on Nurse Education and Practice and consult with nursing 
associations including the National Coalition of Ethnic 
Minority Nurse Associations,’’; and 
(B) by inserting before the period the following: ‘‘, 
and other organizations determined appropriate by the Sec-
retary’’. 
SEC. 5405. PRIMARY CARE EXTENSION PROGRAM. 
Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 5313, is further amended 
by adding at the end the following: 
‘‘SEC. 399W. PRIMARY CARE EXTENSION PROGRAM. 
‘‘(a) ESTABLISHMENT, PURPOSE AND DEFINITION.— 
‘‘(1) IN
GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Quality, 
shall establish a Primary Care Extension Program. 
‘‘(2) PURPOSE.—The Primary Care Extension Program shall 
provide support and assistance to primary care providers to 
educate providers about preventive medicine, health promotion, 
chronic disease management, mental and behavioral health 
services (including substance abuse prevention and treatment 
services), and evidence-based and evidence-informed therapies 
and techniques, in order to enable providers to incorporate 
such matters into their practice and to improve community 
health by working with community-based health connectors 
(referred to in this section as ‘Health Extension Agents’). 
‘‘(3) DEFINITIONS.—In this section: 
‘‘(A) HEALTH
EXTENSION
AGENT.—The term ‘Health 
Extension Agent’ means any local, community-based health 
worker who facilitates and provides assistance to primary 
care practices by implementing quality improvement or
H. R. 3590—532 
system redesign, incorporating the principles of the patient- 
centered medical home to provide high-quality, effective, 
efficient, and safe primary care and to provide guidance 
to patients in culturally and linguistically appropriate 
ways, and linking practices to diverse health system 
resources. 
‘‘(B) PRIMARY CARE PROVIDER.—The term ‘primary care 
provider’ means a clinician who provides integrated, acces-
sible health care services and who is accountable for 
addressing a large majority of personal health care needs, 
including providing preventive and health promotion serv-
ices for men, women, and children of all ages, developing 
a sustained partnership with patients, and practicing in 
the context of family and community, as recognized by 
a State licensing or regulatory authority, unless otherwise 
specified in this section. 
‘‘(b) GRANTS TO ESTABLISH STATE HUBS AND LOCAL PRIMARY 
CARE EXTENSION AGENCIES.— 
‘‘(1) GRANTS.—The Secretary shall award competitive 
grants to States for the establishment of State- or multistate- 
level primary care Primary Care Extension Program State Hubs 
(referred to in this section as ‘Hubs’). 
‘‘(2) COMPOSITION OF HUBS.—A Hub established by a State 
pursuant to paragraph (1)— 
‘‘(A) shall consist of, at a minimum, the State health 
department, the entity responsible for administering the 
State Medicaid program (if other than the State health 
department), the State-level entity administering the Medi-
care program, and the departments of 1 or more health 
professions schools in the State that train providers in 
primary care; and 
‘‘(B) may include entities such as hospital associations, 
primary care practice-based research networks, health 
professional societies, State primary care associations, 
State licensing boards, organizations with a contract with 
the Secretary under section 1153 of the Social Security 
Act, consumer groups, and other appropriate entities. 
‘‘(c) STATE AND LOCAL ACTIVITIES.— 
‘‘(1) HUB
ACTIVITIES.—Hubs established under a grant 
under subsection (b) shall— 
‘‘(A) submit to the Secretary a plan to coordinate func-
tions with quality improvement organizations and area 
health education centers if such entities are members of 
the Hub not described in subsection (b)(2)(A); 
‘‘(B) contract with a county- or local-level entity that 
shall serve as the Primary Care Extension Agency to 
administer the services described in paragraph (2); 
‘‘(C) organize and administer grant funds to county- 
or local-level Primary Care Extension Agencies that serve 
a catchment area, as determined by the State; and 
‘‘(D) organize State-wide or multistate networks of 
local-level Primary Care Extension Agencies to share and 
disseminate information and practices. 
‘‘(2) LOCAL PRIMARY CARE EXTENSION AGENCY ACTIVITIES.— 
‘‘(A) REQUIRED ACTIVITIES.—Primary Care Extension 
Agencies established by a Hub under paragraph (1) shall—
H. R. 3590—533 
‘‘(i) assist primary care providers to implement 
a patient-centered medical home to improve the acces-
sibility, quality, and efficiency of primary care services, 
including health homes; 
‘‘(ii) develop and support primary care learning 
communities to enhance the dissemination of research 
findings 
for 
evidence-based 
practice, 
assess 
implementation of practice improvement, share best 
practices, and involve community clinicians in the 
generation of new knowledge and identification of 
important questions for research; 
‘‘(iii) participate in a national network of Primary 
Care Extension Hubs and propose how the Primary 
Care Extension Agency will share and disseminate les-
sons learned and best practices; and 
‘‘(iv) develop a plan for financial sustainability 
involving State, local, and private contributions, to pro-
vide for the reduction in Federal funds that is expected 
after an initial 6-year period of program establishment, 
infrastructure development, and planning. 
‘‘(B) DISCRETIONARY ACTIVITIES.—Primary Care Exten-
sion Agencies established by a Hub under paragraph (1) 
may— 
‘‘(i) provide technical assistance, training, and 
organizational support for community health teams 
established under section 3602 of the Patient Protec-
tion and Affordable Care Act; 
‘‘(ii) collect data and provision of primary care 
provider feedback from standardized measurements of 
processes and outcomes to aid in continuous perform-
ance improvement; 
‘‘(iii) collaborate with local health departments, 
community health centers, tribes and tribal entities, 
and other community agencies to identify community 
health priorities and local health workforce needs, and 
participate in community-based efforts to address the 
social and primary determinants of health, strengthen 
the local primary care workforce, and eliminate health 
disparities; 
‘‘(iv) develop measures to monitor the impact of 
the proposed program on the health of practice 
enrollees and of the wider community served; and 
‘‘(v) participate in other activities, as determined 
appropriate by the Secretary. 
‘‘(d) FEDERAL PROGRAM ADMINISTRATION.— 
‘‘(1) GRANTS; TYPES.—Grants awarded under subsection (b) 
shall be— 
‘‘(A) program grants, that are awarded to State or 
multistate entities that submit fully-developed plans for 
the implementation of a Hub, for a period of 6 years; 
or 
‘‘(B) planning grants, that are awarded to State or 
multistate entities with the goal of developing a plan for 
a Hub, for a period of 2 years. 
‘‘(2) APPLICATIONS.—To be eligible for a grant under sub-
section (b), a State or multistate entity shall submit to the
H. R. 3590—534 
Secretary an application, at such time, in such manner, and 
containing such information as the Secretary may require. 
‘‘(3) EVALUATION.—A State that receives a grant under 
subsection (b) shall be evaluated at the end of the grant period 
by an evaluation panel appointed by the Secretary. 
‘‘(4) CONTINUING SUPPORT.—After the sixth year in which 
assistance is provided to a State under a grant awarded under 
subsection (b), the State may receive additional support under 
this section if the State program has received satisfactory 
evaluations with respect to program performance and the 
merits of the State sustainability plan, as determined by the 
Secretary. 
‘‘(5) LIMITATION.—A State shall not use in excess of 10 
percent of the amount received under a grant to carry out 
administrative activities under this section. Funds awarded 
pursuant to this section shall not be used for funding direct 
patient care. 
‘‘(e) REQUIREMENTS ON THE SECRETARY.—In carrying out this 
section, the Secretary shall consult with the heads of other Federal 
agencies with demonstrated experience and expertise in health 
care and preventive medicine, such as the Centers for Disease 
Control and Prevention, the Substance Abuse and Mental Health 
Administration, the Health Resources and Services Administration, 
the National Institutes of Health, the Office of the National Coordi-
nator for Health Information Technology, the Indian Health Service, 
the Agricultural Cooperative Extension Service of the Department 
of Agriculture, and other entities, as the Secretary determines 
appropriate. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To awards grants as 
provided in subsection (d), there are authorized to be appropriated 
$120,000,000 for each of fiscal years 2011 and 2012, and such 
sums as may be necessary to carry out this section for each of 
fiscal years 2013 through 2014.’’. 
Subtitle F—Strengthening Primary Care 
and Other Workforce Improvements 
SEC. 5501. EXPANDING ACCESS TO PRIMARY CARE SERVICES AND GEN-
ERAL SURGERY SERVICES. 
(a) INCENTIVE PAYMENT PROGRAM FOR PRIMARY CARE SERV-
ICES.— 
(1) IN GENERAL.—Section 1833 of the Social Security Act 
(42 U.S.C. 1395l) is amended by adding at the end the following 
new subsection: 
‘‘(x) INCENTIVE PAYMENTS FOR PRIMARY CARE SERVICES.— 
‘‘(1) IN
GENERAL.—In the case of primary care services 
furnished on or after January 1, 2011, and before January 
1, 2016, by a primary care practitioner, in addition to the 
amount of payment that would otherwise be made for such 
services under this part, there also shall be paid (on a monthly 
or quarterly basis) an amount equal to 10 percent of the pay-
ment amount for the service under this part. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) PRIMARY CARE PRACTITIONER.—The term ‘primary 
care practitioner’ means an individual— 
‘‘(i) who—