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branch for purposes of applying title I of the 
Ethics in Government Act of 1978 (Public Law 
95–521). 
‘‘(D) CONFLICTS OF INTEREST.—No indi-
vidual may serve as an appointed member if 
that individual engages in any other business, 
vocation, or employment. 
‘‘(E) CONSULTATION WITH CONGRESS.—In 
selecting individuals for nominations for ap-
pointments to the Board, the President shall con-
sult with— 
‘‘(i) the majority leader of the Senate 
concerning the appointment of 3 members; 
‘‘(ii) the Speaker of the House of Rep-
resentatives concerning the appointment of 
3 members; 
‘‘(iii) the minority leader of the Senate 
concerning the appointment of 3 members; 
and 
‘‘(iv) the minority leader of the House 
of Representatives concerning the appoint-
ment of 3 members. 
‘‘(2) TERM OF OFFICE.—Each appointed member 
shall hold office for a term of 6 years except that—
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‘‘(A) a member may not serve more than 2 
full consecutive terms (but may be reappointed to 
2 full consecutive terms after being appointed to 
fill a vacancy on the Board); 
‘‘(B) a member appointed to fill a vacancy 
occurring prior to the expiration of the term for 
which that member’s predecessor was appointed 
shall be appointed for the remainder of such 
term; 
‘‘(C) a member may continue to serve after 
the expiration of the member’s term until a suc-
cessor has taken office; and 
‘‘(D) of the members first appointed under 
this section, 5 shall be appointed for a term of 
1 year, 5 shall be appointed for a term of 3 
years, and 5 shall be appointed for a term of 6 
years, the term of each to be designated by the 
President at the time of nomination. 
‘‘(3) CHAIRPERSON.— 
‘‘(A) IN GENERAL.—The Chairperson shall 
be appointed by the President, by and with the 
advice and consent of the Senate, from among 
the members of the Board. 
‘‘(B) DUTIES.—The Chairperson shall be 
the principal executive officer of the Board, and
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shall exercise all of the executive and administra-
tive functions of the Board, including functions 
of the Board with respect to— 
‘‘(i) the appointment and supervision 
of personnel employed by the Board; 
‘‘(ii) 
the 
distribution 
of 
business 
among personnel appointed and supervised 
by the Chairperson and among administra-
tive units of the Board; and 
‘‘(iii) the use and expenditure of funds. 
‘‘(C) GOVERNANCE.—In carrying out any of 
the functions under subparagraph (B), the 
Chairperson shall be governed by the general 
policies established by the Board and by the deci-
sions, findings, and determinations the Board 
shall by law be authorized to make. 
‘‘(D) REQUESTS
FOR
APPROPRIATIONS.— 
Requests or estimates for regular, supplemental, 
or deficiency appropriations on behalf of the 
Board may not be submitted by the Chairperson 
without the prior approval of a majority vote of 
the Board. 
‘‘(4) REMOVAL.—Any appointed member may be 
removed by the President for neglect of duty or mal-
feasance in office, but for no other cause.
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‘‘(h) VACANCIES; QUORUM; SEAL; VICE CHAIRPERSON; 
VOTING ON REPORTS.— 
‘‘(1) VACANCIES.—No vacancy on the Board 
shall impair the right of the remaining members to 
exercise all the powers of the Board. 
‘‘(2) QUORUM.—A majority of the appointed 
members of the Board shall constitute a quorum for 
the transaction of business, but a lesser number of 
members may hold hearings. 
‘‘(3) SEAL.—The Board shall have an official 
seal, of which judicial notice shall be taken. 
‘‘(4) VICE CHAIRPERSON.—The Board shall an-
nually elect a Vice Chairperson to act in the absence 
or disability of the Chairperson or in case of a va-
cancy in the office of the Chairperson. 
‘‘(5) VOTING ON PROPOSALS.—Any proposal of 
the Board must be approved by the majority of ap-
pointed members present. 
‘‘(i) POWERS OF THE BOARD.— 
‘‘(1) HEARINGS.—The Board may hold such 
hearings, sit and act at such times and places, take 
such testimony, and receive such evidence as the 
Board considers advisable to carry out this section. 
‘‘(2) AUTHORITY TO INFORM RESEARCH PRIOR-
ITIES FOR DATA COLLECTION.—The Board may ad-
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vise the Secretary on priorities for health services re-
search, particularly as such priorities pertain to nec-
essary changes and issues regarding payment reforms 
under Medicare. 
‘‘(3) OBTAINING
OFFICIAL
DATA.—The Board 
may secure directly from any department or agency 
of the United States information necessary to enable 
it to carry out this section. Upon request of the 
Chairperson, the head of that department or agency 
shall furnish that information to the Board on an 
agreed upon schedule. 
‘‘(4) POSTAL SERVICES.—The Board may use the 
United States mails in the same manner and under 
the same conditions as other departments and agen-
cies of the Federal Government. 
‘‘(5) GIFTS.—The Board may accept, use, and 
dispose of gifts or donations of services or property. 
‘‘(6) OFFICES.—The Board shall maintain a 
principal office and such field offices as it determines 
necessary, and may meet and exercise any of its pow-
ers at any other place. 
‘‘(j) PERSONNEL MATTERS.— 
‘‘(1) COMPENSATION OF MEMBERS AND CHAIR-
PERSON.—Each appointed member, other than the 
Chairperson, shall be compensated at a rate equal to
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ter 51 and subchapter III of chapter 53 of title 
5, United States Code, relating to classification 
of positions and General Schedule pay rates, ex-
cept that the rate of pay for the executive direc-
tor and other personnel may not exceed the rate 
payable for level V of the Executive Schedule 
under section 5316 of such title. 
‘‘(4) DETAIL
OF
GOVERNMENT
EMPLOYEES.— 
Any Federal Government employee may be detailed to 
the Board without reimbursement, and such detail 
shall be without interruption or loss of civil service 
status or privilege. 
‘‘(5) PROCUREMENT OF TEMPORARY AND INTER-
MITTENT SERVICES.—The Chairperson may procure 
temporary and intermittent services under section 
3109(b) of title 5, United States Code, at rates for in-
dividuals which do not exceed the daily equivalent of 
the annual rate of basic pay prescribed for level V of 
the Executive Schedule under section 5316 of such 
title. 
‘‘(k) CONSUMER ADVISORY COUNCIL.— 
‘‘(1) IN GENERAL.—There is established a con-
sumer advisory council to advise the Board on the 
impact of payment policies under this title on con-
sumers.
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‘‘(2) MEMBERSHIP.— 
‘‘(A) NUMBER
AND
APPOINTMENT.—The 
consumer advisory council shall be composed of 
10 consumer representatives appointed by the 
Comptroller General of the United States, 1 from 
among each of the 10 regions established by the 
Secretary as of the date of enactment of this sec-
tion. 
‘‘(B) QUALIFICATIONS.—The membership of 
the council shall represent the interests of con-
sumers and particular communities. 
‘‘(3) DUTIES.—The consumer advisory council 
shall, subject to the call of the Board, meet not less 
frequently than 2 times each year in the District of 
Columbia. 
‘‘(4) OPEN MEETINGS.—Meetings of the consumer 
advisory council shall be open to the public. 
‘‘(5) ELECTION OF OFFICERS.—Members of the 
consumer advisory council shall elect their own offi-
cers. 
‘‘(6) APPLICATION OF FACA.—The Federal Advi-
sory Committee Act (5 U.S.C. App.) shall apply to 
the consumer advisory council except that section 14 
of such Act shall not apply. 
‘‘(l) DEFINITIONS.—In this section:
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‘‘(1) 
BOARD; 
CHAIRPERSON; 
MEMBER.—The 
terms ‘Board’, ‘Chairperson’, and ‘Member’ mean the 
Independent Medicare Advisory Board established 
under subsection (a) and the Chairperson and any 
Member thereof, respectively. 
‘‘(2) MEDICARE.—The term ‘Medicare’ means the 
program established under this title, including parts 
A, B, C, and D. 
‘‘(3) MEDICARE BENEFICIARY.—The term ‘Medi-
care beneficiary’ means an individual who is entitled 
to, or enrolled for, benefits under part A or enrolled 
for benefits under part B. 
‘‘(4) MEDICARE PROGRAM SPENDING.—The term 
‘Medicare program spending’ means program spend-
ing under parts A, B, and D net of premiums. 
‘‘(m) FUNDING.— 
‘‘(1) IN GENERAL.—There are appropriated to 
the Board to carry out its duties and functions— 
‘‘(A) for fiscal year 2012, $15,000,000; and 
‘‘(B) for each subsequent fiscal year, the 
amount appropriated under this paragraph for 
the previous fiscal year increased by the annual 
percentage increase in the Consumer Price Index 
for All Urban Consumers (all items; United
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States city average) as of June of the previous 
fiscal year. 
‘‘(2) FROM
TRUST
FUNDS.—Sixty percent of 
amounts appropriated under paragraph (1) shall be 
derived by transfer from the Federal Hospital Insur-
ance Trust Fund under section 1817 and 40 percent 
of amounts appropriated under such paragraph shall 
be derived by transfer from the Federal Supple-
mentary Medical Insurance Trust Fund under section 
1841.’’. 
(2) LOBBYING COOLING-OFF PERIOD FOR MEM-
BERS
OF
THE
INDEPENDENT
MEDICARE
ADVISORY 
BOARD.—Section 207(c) of title 18, United States 
Code, is amended by inserting at the end the fol-
lowing: 
‘‘(3) MEMBERS OF THE INDEPENDENT MEDICARE 
ADVISORY BOARD.— 
‘‘(A) IN
GENERAL.—Paragraph (1) shall 
apply to a member of the Independent Medicare 
Advisory Board under section 1899A. 
‘‘(B) AGENCIES AND CONGRESS.—For pur-
poses of paragraph (1), the agency in which the 
individual described in subparagraph (A) served 
shall be considered to be the Independent Medi-
care Advisory Board, the Department of Health
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and Human Services, and the relevant commit-
tees of jurisdiction of Congress, including the 
Committee on Ways and Means and the Com-
mittee on Energy and Commerce of the House of 
Representatives and the Committee on Finance 
of the Senate.’’. 
(b) GAO STUDY AND REPORT ON DETERMINATION 
AND IMPLEMENTATION OF PAYMENT AND COVERAGE POLI-
CIES UNDER THE MEDICARE PROGRAM.— 
(1) INITIAL STUDY AND REPORT.— 
(A) STUDY.—The Comptroller General of 
the United States (in this section referred to as 
the ‘‘Comptroller General’’) shall conduct a study 
on changes to payment policies, methodologies, 
and rates and coverage policies and methodolo-
gies under the Medicare program under title 
XVIII of the Social Security Act as a result of 
the recommendations contained in the proposals 
made by the Independent Medicare Advisory 
Board under section 1899A of such Act (as added 
by subsection (a)), including an analysis of the 
effect of such recommendations on— 
(i) Medicare beneficiary access to pro-
viders and items and services;
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(ii) the affordability of Medicare pre-
miums 
and 
cost-sharing 
(including 
deductibles, coinsurance, and copayments); 
(iii) the potential impact of changes on 
other government or private-sector pur-
chasers and payers of care; and 
(iv) quality of patient care, including 
patient experience, outcomes, and other 
measures of care. 
(B) REPORT.—Not later than July 1, 2015, 
the Comptroller General shall submit to Congress 
a report containing the results of the study con-
ducted under subparagraph (A), together with 
recommendations for such legislation and ad-
ministrative action as the Comptroller General 
determines appropriate. 
(2) SUBSEQUENT STUDIES AND REPORTS.—The 
Comptroller General shall periodically conduct such 
additional studies and submit reports to Congress on 
changes to Medicare payments policies, methodologies, 
and rates and coverage policies and methodologies as 
the Comptroller General determines appropriate, in 
consultation with the Committee on Ways and Means 
and the Committee on Energy and Commerce of the
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House of Representatives and the Committee on Fi-
nance of the Senate. 
(c) CONFORMING AMENDMENTS.—Section 1805(b) of 
the Social Security Act (42 U.S.C. 1395b–6(b)) is amend-
ed— 
(1) by redesignating paragraphs (4) through (8) 
as paragraphs (5) through (9), respectively; and 
(2) by inserting after paragraph (3) the fol-
lowing: 
‘‘(4) REVIEW
AND
COMMENT
ON
THE
INDE-
PENDENT
MEDICARE
ADVISORY
BOARD
OR
SECRE-
TARIAL PROPOSAL.—If the Independent Medicare Ad-
visory Board (as established under subsection (a) of 
section 1899A) or the Secretary submits a proposal to 
the Commission under such section in a year, the 
Commission shall review the proposal and, not later 
than March 1 of that year, submit to the Committee 
on Ways and Means and the Committee on Energy 
and Commerce of the House of Representatives and 
the Committee on Finance of the Senate written com-
ments on such proposal. Such comments may include 
such recommendations as the Commission deems ap-
propriate.’’.
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Subtitle F—Health Care Quality 
Improvements 
SEC. 3501. HEALTH CARE DELIVERY SYSTEM RESEARCH; 
QUALITY IMPROVEMENT TECHNICAL ASSIST-
ANCE. 
Part D of title IX of the Public Health Service Act, 
as amended by section 3013, is further amended by adding 
at the end the following: 
‘‘Subpart II—Health Care Quality Improvement 
Programs 
‘‘SEC. 933. HEALTH CARE DELIVERY SYSTEM RESEARCH. 
‘‘(a) PURPOSE.—The purposes of this section are to— 
‘‘(1) enable the Director to identify, develop, 
evaluate, disseminate, and provide training in inno-
vative methodologies and strategies for quality im-
provement practices in the delivery of health care 
services that represent best practices (referred to as 
‘best practices’) in health care quality, safety, and 
value; and 
‘‘(2) ensure that the Director is accountable for 
implementing a model to pursue such research in a 
collaborative manner with other related Federal agen-
cies. 
‘‘(b) GENERAL FUNCTIONS
OF
THE CENTER.—The 
Center for Quality Improvement and Patient Safety of the
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Agency for Healthcare Research and Quality (referred to 
in this section as the ‘Center’), or any other relevant agency 
or department designated by the Director, shall— 
‘‘(1) carry out its functions using research from 
a variety of disciplines, which may include epidemi-
ology, health services, sociology, psychology, human 
factors engineering, biostatistics, health economics, 
clinical research, and health informatics; 
‘‘(2) conduct or support activities consistent with 
the purposes described in subsection (a), and for— 
‘‘(A) best practices for quality improvement 
practices in the delivery of health care services; 
and 
‘‘(B) that include changes in processes of 
care and the redesign of systems used by pro-
viders that will reliably result in intended health 
outcomes, improve patient safety, and reduce 
medical errors (such as skill development for 
health care providers in team-based health care 
delivery and rapid cycle process improvement) 
and facilitate adoption of improved workflow; 
‘‘(3) identify health care providers, including 
health care systems, single institutions, and indi-
vidual providers, that—
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‘‘(A) deliver consistently high-quality, effi-
cient health care services (as determined by the 
Secretary); and 
‘‘(B) employ best practices that are adapt-
able and scalable to diverse health care settings 
or effective in improving care across diverse set-
tings; 
‘‘(4) assess research, evidence, and knowledge 
about what strategies and methodologies are most ef-
fective in improving health care delivery; 
‘‘(5) find ways to translate such information 
rapidly and effectively into practice, and document 
the sustainability of those improvements; 
‘‘(6) create strategies for quality improvement 
through the development of tools, methodologies, and 
interventions that can successfully reduce variations 
in the delivery of health care; 
‘‘(7) identify, measure, and improve organiza-
tional, human, or other causative factors, including 
those related to the culture and system design of a 
health care organization, that contribute to the success 
and sustainability of specific quality improvement 
and patient safety strategies; 
‘‘(8) provide for the development of best practices 
in the delivery of health care services that—
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‘‘(A) have a high likelihood of success, based 
on structured review of empirical evidence; 
‘‘(B) are specified with sufficient detail of 
the individual processes, steps, training, skills, 
and knowledge required for implementation and 
incorporation into workflow of health care prac-
titioners in a variety of settings; 
‘‘(C) are designed to be readily adapted by 
health care providers in a variety of settings; 
and 
‘‘(D) where applicable, assist health care 
providers in working with other health care pro-
viders across the continuum of care and in en-
gaging patients and their families in improving 
the care and patient health outcomes; 
‘‘(9) provide for the funding of the activities of 
organizations with recognized expertise and excellence 
in improving the delivery of health care services, in-
cluding children’s health care, by involving multiple 
disciplines, managers of health care entities, broad de-
velopment and training, patients, caregivers and fam-
ilies, and frontline health care workers, including ac-
tivities for the examination of strategies to share best 
quality improvement practices and to promote excel-
lence in the delivery of health care services; and
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‘‘(10) build capacity at the State and commu-
nity level to lead quality and safety efforts through 
education, training, and mentoring programs to 
carry out the activities under paragraphs (1) through 
(9). 
‘‘(c) RESEARCH FUNCTIONS OF CENTER.— 
‘‘(1) IN
GENERAL.—The Center shall support, 
such as through a contract or other mechanism, re-
search on health care delivery system improvement 
and the development of tools to facilitate adoption of 
best practices that improve the quality, safety, and ef-
ficiency of health care delivery services. Such support 
may include establishing a Quality Improvement Net-
work Research Program for the purpose of testing, 
scaling, and disseminating of interventions to im-
prove quality and efficiency in health care. Recipients 
of funding under the Program may include national, 
State, multi-State, or multi-site quality improvement 
networks. 
‘‘(2) RESEARCH REQUIREMENTS.—The research 
conducted pursuant to paragraph (1) shall— 
‘‘(A) address the priorities identified by the 
Secretary in the national strategic plan estab-
lished under section 399HH;
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‘‘(B) identify areas in which evidence is in-
sufficient to identify strategies and methodolo-
gies, taking into consideration areas of insuffi-
cient evidence identified by the entity with a 
contract under section 1890(a) of the Social Se-
curity Act in the report required under section 
399JJ; 
‘‘(C) address concerns identified by health 
care institutions and providers and commu-
nicated through the Center pursuant to sub-
section (d); 
‘‘(D) reduce preventable morbidity, mor-
tality, and associated costs of morbidity and 
mortality by building capacity for patient safety 
research; 
‘‘(E) support the discovery of processes for 
the reliable, safe, efficient, and responsive deliv-
ery of health care, taking into account discov-
eries from clinical research and comparative ef-
fectiveness research; 
‘‘(F) allow communication of research find-
ings and translate evidence into practice rec-
ommendations that are adaptable to a variety of 
settings, and which, as soon as practicable after 
the establishment of the Center, shall include—
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‘‘(ii) using the results of such analyses 
to develop scientific methods of response to 
such events; 
‘‘(I) include the conduct of systematic re-
views of existing practices that improve the qual-
ity, safety, and efficiency of health care delivery, 
as well as new research on improving such prac-
tices; and 
‘‘(J) include the examination of how to 
measure and evaluate the progress of quality and 
patient safety activities. 
‘‘(d) DISSEMINATION OF RESEARCH FINDINGS.— 
‘‘(1) PUBLIC AVAILABILITY.—The Director shall 
make the research findings of the Center available to 
the public through multiple media and appropriate 
formats to reflect the varying needs of health care pro-
viders and consumers and diverse levels of health lit-
eracy. 
‘‘(2) LINKAGE TO HEALTH INFORMATION TECH-
NOLOGY.—The Secretary shall ensure that research 
findings and results generated by the Center are 
shared with the Office of the National Coordinator of 
Health Information Technology and used to inform 
the activities of the health information technology ex-
tension program under section 3012, as well as any
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relevant standards, certification criteria, or imple-
mentation specifications. 
‘‘(e) PRIORITIZATION.—The Director shall identify 
and regularly update a list of processes or systems on which 
to focus research and dissemination activities of the Center, 
taking into account— 
‘‘(1) the cost to Federal health programs; 
‘‘(2) consumer assessment of health care experi-
ence; 
‘‘(3) provider assessment of such processes or sys-
tems and opportunities to minimize distress and in-
jury to the health care workforce; 
‘‘(4) the potential impact of such processes or 
systems on health status and function of patients, in-
cluding vulnerable populations including children; 
‘‘(5) the areas of insufficient evidence identified 
under subsection (c)(2)(B); and 
‘‘(6) the evolution of meaningful use of health in-
formation technology, as defined in section 3000. 
‘‘(f) COORDINATION.—The Center shall coordinate its 
activities with activities conducted by the Center for Medi-
care and Medicaid Innovation established under section 
1115A of the Social Security Act.
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‘‘(g) FUNDING.—There is authorized to be appro-
priated to carry out this section $20,000,000 for fiscal years 
2010 through 2014. 
‘‘SEC. 934. QUALITY IMPROVEMENT TECHNICAL ASSIST-
ANCE AND IMPLEMENTATION. 
‘‘(a) IN GENERAL.—The Director, through the Center 
for Quality Improvement and Patient Safety of the Agency 
for Healthcare Research and Quality (referred to in this 
section as the ‘Center’), shall award— 
‘‘(1) technical assistance grants or contracts to 
eligible entities to provide technical support to insti-
tutions that deliver health care and health care pro-
viders (including rural and urban providers of serv-
ices and suppliers with limited infrastructure and fi-
nancial resources to implement and support quality 
improvement activities, providers of services and sup-
pliers with poor performance scores, and providers of 
services and suppliers for which there are disparities 
in care among subgroups of patients) so that such in-
stitutions and providers understand, adapt, and im-
plement the models and practices identified in the re-
search conducted by the Center, including the Quality 
Improvement Networks Research Program; and
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‘‘(2) implementation grants or contracts to eligi-
ble entities to implement the models and practices de-
scribed under paragraph (1). 
‘‘(b) ELIGIBLE ENTITIES.— 
‘‘(1) TECHNICAL ASSISTANCE AWARD.—To be eli-
gible to receive a technical assistance grant or con-
tract under subsection (a)(1), an entity— 
‘‘(A) may be a health care provider, health 
care provider association, professional society, 
health care worker organization, Indian health 
organization, quality improvement organization, 
patient safety organization, local quality im-
provement collaborative, the Joint Commission, 
academic health center, university, physician- 
based research network, primary care extension 
program established under section 399W, a Fed-
eral Indian Health Service program or a health 
program operated by an Indian tribe (as defined 
in section 4 of the Indian Health Care Improve-
ment Act), or any other entity identified by the 
Secretary; and 
‘‘(B) shall have demonstrated expertise in 
providing information and technical support 
and assistance to health care providers regarding 
quality improvement.
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‘‘(2) IMPLEMENTATION AWARD.—To be eligible to 
receive an implementation grant or contract under 
subsection (a)(2), an entity— 
‘‘(A) may be a hospital or other health care 
provider or consortium or providers, as deter-
mined by the Secretary; and 
‘‘(B) shall have demonstrated expertise in 
providing information and technical support 
and assistance to health care providers regarding 
quality improvement. 
‘‘(c) APPLICATION.— 
‘‘(1) TECHNICAL
ASSISTANCE
AWARD.—To re-
ceive a technical assistance grant or contract under 
subsection (a)(1), an eligible entity shall submit an 
application to the Secretary at such time, in such 
manner, and containing— 
‘‘(A) a plan for a sustainable business 
model that may include a system of— 
‘‘(i) charging fees to institutions and 
providers that receive technical support 
from the entity; and 
‘‘(ii) reducing or eliminating such fees 
for such institutions and providers that 
serve low-income populations; and
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‘‘(B) such other information as the Director 
may require. 
‘‘(2) IMPLEMENTATION
AWARD.—To receive a 
grant or contract under subsection (a)(2), an eligible 
entity shall submit an application to the Secretary at 
such time, in such manner, and containing— 
‘‘(A) a plan for implementation of a model 
or practice identified in the research conducted 
by the Center including— 
‘‘(i) financial cost, staffing require-
ments, and timeline for implementation; 
and 
‘‘(ii) pre- and projected post-implemen-
tation quality measure performance data in 
targeted improvement areas identified by 
the Secretary; and 
‘‘(B) such other information as the Director 
may require. 
‘‘(d) MATCHING
FUNDS.—The Director may not 
award a grant or contract under this section to an entity 
unless the entity agrees that it will make available (directly 
or through contributions from other public or private enti-
ties) non-Federal contributions toward the activities to be 
carried out under the grant or contract in an amount equal 
to $1 for each $5 of Federal funds provided under the grant
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renew a grant or contract with such entity under this 
section. 
‘‘(f) COORDINATION.—The entities that receive a grant 
or contract under this section shall coordinate with health 
information technology regional extension centers under 
section 3012(c) and the primary care extension program 
established under section 399W regarding the dissemination 
of quality improvement, system delivery reform, and best 
practices information.’’. 
SEC. 3502. ESTABLISHING COMMUNITY HEALTH TEAMS TO 
SUPPORT THE PATIENT-CENTERED MEDICAL 
HOME. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall establish a program to provide grants to or 
enter into contracts with eligible entities to establish com-
munity-based interdisciplinary, interprofessional teams 
(referred to in this section as ‘‘health teams’’) to support 
primary care practices, including obstetrics and gynecology 
practices, within the hospital service areas served by the 
eligible entities. Grants or contracts shall be used to— 
(1) establish health teams to provide support 
services to primary care providers; and 
(2) provide capitated payments to primary care 
providers as determined by the Secretary.
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(b) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant or contract under subsection (a), an entity shall— 
(1)(A) be a State or State-designated entity; or 
(B) be an Indian tribe or tribal organization, as 
defined in section 4 of the Indian Health Care Im-
provement Act; 
(2) submit a plan for achieving long-term finan-
cial sustainability within 3 years; 
(3) submit a plan for incorporating prevention 
initiatives and patient education and care manage-
ment resources into the delivery of health care that is 
integrated with community-based prevention and 
treatment resources, where available; 
(4) ensure that the health team established by the 
entity includes an interdisciplinary, interprofessional 
team of health care providers, as determined by the 
Secretary; such team may include medical specialists, 
nurses, pharmacists, nutritionists, dieticians, social 
workers, behavioral and mental health providers (in-
cluding substance use disorder prevention and treat-
ment providers), doctors of chiropractic, licensed com-
plementary and alternative medicine practitioners, 
and physicians’ assistants; 
(5) agree to provide services to eligible individ-
uals with chronic conditions, as described in section
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1945 of the Social Security Act (as added by section 
2703), in accordance with the payment methodology 
established under subsection (c) of such section; and 
(6) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
(c) REQUIREMENTS FOR HEALTH TEAMS.—A health 
team established pursuant to a grant or contract under sub-
section (a) shall— 
(1) establish contractual agreements with pri-
mary care providers to provide support services; 
(2) support patient-centered medical homes, de-
fined as a mode of care that includes— 
(A) personal physicians; 
(B) whole person orientation; 
(C) coordinated and integrated care; 
(D) safe and high-quality care through evi-
dence-informed medicine, appropriate use of 
health information technology, and continuous 
quality improvements; 
(E) expanded access to care; and 
(F) payment that recognizes added value 
from additional components of patient-centered 
care;
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(3) collaborate with local primary care providers 
and existing State and community based resources to 
coordinate disease prevention, chronic disease man-
agement, transitioning between health care providers 
and settings and case management for patients, in-
cluding children, with priority given to those ame-
nable to prevention and with chronic diseases or con-
ditions identified by the Secretary; 
(4) in collaboration with local health care pro-
viders, develop and implement interdisciplinary, 
interprofessional care plans that integrate clinical 
and community preventive and health promotion 
services for patients, including children, with a pri-
ority given to those amenable to prevention and with 
chronic diseases or conditions identified by the Sec-
retary; 
(5) incorporate health care providers, patients, 
caregivers, and authorized representatives in program 
design and oversight; 
(6) provide support necessary for local primary 
care providers to— 
(A) coordinate and provide access to high- 
quality health care services; 
(B) coordinate and provide access to pre-
ventive and health promotion services;
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(C) provide access to appropriate specialty 
care and inpatient services; 
(D) provide quality-driven, cost-effective, 
culturally appropriate, and patient- and family- 
centered health care; 
(E) provide access to pharmacist-delivered 
medication 
management 
services, 
including 
medication reconciliation; 
(F) provide coordination of the appropriate 
use of complementary and alternative (CAM) 
services to those who request such services; 
(G) promote effective strategies for treat-
ment planning, monitoring health outcomes and 
resource use, sharing information, treatment de-
cision support, and organizing care to avoid du-
plication of service and other medical manage-
ment approaches intended to improve quality 
and value of health care services; 
(H) provide local access to the continuum of 
health care services in the most appropriate set-
ting, including access to individuals that imple-
ment the care plans of patients and coordinate 
care, such as integrative health care practi-
tioners;
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(I) collect and report data that permits 
evaluation of the success of the collaborative ef-
fort on patient outcomes, including collection of 
data on patient experience of care, and identi-
fication of areas for improvement; and 
(J) establish a coordinated system of early 
identification and referral for children at risk 
for developmental or behavioral problems such as 
through the use of infolines, health information 
technology, or other means as determined by the 
Secretary; 
(7) provide 24-hour care management and sup-
port during transitions in care settings including— 
(A) a transitional care program that pro-
vides onsite visits from the care coordinator, as-
sists with the development of discharge plans and 
medication reconciliation upon admission to and 
discharge from the hospitals, nursing home, or 
other institution setting; 
(B) discharge planning and counseling sup-
port to providers, patients, caregivers, and au-
thorized representatives; 
(C) assuring that post-discharge care plans 
include medication management, as appropriate;
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(D) referrals for mental and behavioral 
health services, which may include the use of 
infolines; and 
(E) transitional health care needs from ado-
lescence to adulthood; 
(8) serve as a liaison to community prevention 
and treatment programs; 
(9) demonstrate a capacity to implement and 
maintain health information technology that meets 
the requirements of certified EHR technology (as de-
fined in section 3000 of the Public Health Service Act 
(42 U.S.C. 300jj)) to facilitate coordination among 
members of the applicable care team and affiliated 
primary care practices; and 
(10) where applicable, report to the Secretary in-
formation on quality measures used under section 
399JJ of the Public Health Service Act. 
(d) REQUIREMENT FOR PRIMARY CARE PROVIDERS.— 
A provider who contracts with a care team shall— 
(1) provide a care plan to the care team for each 
patient participant; 
(2) provide access to participant health records; 
and 
(3) meet regularly with the care team to ensure 
integration of care.
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(e) REPORTING TO SECRETARY.—An entity that re-
ceives a grant or contract under subsection (a) shall submit 
to the Secretary a report that describes and evaluates, as 
requested by the Secretary, the activities carried out by the 
entity under subsection (c). 
(f) DEFINITION OF PRIMARY CARE.—In this section, 
the term ‘‘primary care’’ means the provision of integrated, 
accessible health care services by clinicians who are ac-
countable for addressing a large majority of personal health 
care needs, developing a sustained partnership with pa-
tients, and practicing in the context of family and commu-
nity. 
SEC. 3503. MEDICATION MANAGEMENT SERVICES IN TREAT-
MENT OF CHRONIC DISEASE. 
Title IX of the Public Health Service Act (42 U.S.C. 
299 et seq.), as amended by section 3501, is further amend-
ed by inserting after section 934 the following: 
‘‘SEC. 935. GRANTS OR CONTRACTS TO IMPLEMENT MEDICA-
TION MANAGEMENT SERVICES IN TREAT-
MENT OF CHRONIC DISEASES. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Patient Safety Research Center established in section 933 
(referred to in this section as the ‘Center’), shall establish 
a program to provide grants or contracts to eligible entities 
to implement medication management (referred to in this
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section as ‘MTM’) services provided by licensed phar-
macists, as a collaborative, multidisciplinary, inter-profes-
sional approach to the treatment of chronic diseases for tar-
geted individuals, to improve the quality of care and reduce 
overall cost in the treatment of such diseases. The Secretary 
shall commence the program under this section not later 
than May 1, 2010. 
‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant or contract under subsection (a), an entity shall— 
‘‘(1) provide a setting appropriate for MTM 
services, as recommended by the experts described in 
subsection (e); 
‘‘(2) submit to the Secretary a plan for achieving 
long-term financial sustainability; 
‘‘(3) where applicable, submit a plan for coordi-
nating MTM services through local community health 
teams established in section 3502 of the Patient Pro-
tection and Affordable Care Act or in collaboration 
with primary care extension programs established in 
section 399W; 
‘‘(4) submit a plan for meeting the requirements 
under subsection (c); and 
‘‘(5) submit to the Secretary such other informa-
tion as the Secretary may require.
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‘‘(c) MTM SERVICES TO TARGETED INDIVIDUALS.— 
The MTM services provided with the assistance of a grant 
or contract awarded under subsection (a) shall, as allowed 
by State law including applicable collaborative pharmacy 
practice agreements, include— 
‘‘(1) performing or obtaining necessary assess-
ments of the health and functional status of each pa-
tient receiving such MTM services; 
‘‘(2) formulating a medication treatment plan 
according to therapeutic goals agreed upon by the 
prescriber and the patient or caregiver or authorized 
representative of the patient; 
‘‘(3) selecting, initiating, modifying, recom-
mending changes to, or administering medication 
therapy; 
‘‘(4) monitoring, which may include access to, 
ordering, or performing laboratory assessments, and 
evaluating the response of the patient to therapy, in-
cluding safety and effectiveness; 
‘‘(5) performing an initial comprehensive medi-
cation review to identify, resolve, and prevent medica-
tion-related problems, including adverse drug events, 
quarterly targeted medication reviews for ongoing 
monitoring, and additional followup interventions on
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a schedule developed collaboratively with the pre-
scriber; 
‘‘(6) documenting the care delivered and commu-
nicating essential information about such care, in-
cluding a summary of the medication review, and the 
recommendations of the pharmacist to other appro-
priate health care providers of the patient in a timely 
fashion; 
‘‘(7) providing education and training designed 
to enhance the understanding and appropriate use of 
the medications by the patient, caregiver, and other 
authorized representative; 
‘‘(8) providing information, support services, 
and resources and strategies designed to enhance pa-
tient adherence with therapeutic regimens; 
‘‘(9) coordinating and integrating MTM services 
within the broader health care management services 
provided to the patient; and 
‘‘(10) such other patient care services allowed 
under pharmacist scopes of practice in use in other 
Federal programs that have implemented MTM serv-
ices. 
‘‘(d) TARGETED INDIVIDUALS.—MTM services pro-
vided by licensed pharmacists under a grant or contract
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awarded under subsection (a) shall be offered to targeted 
individuals who— 
‘‘(1) take 4 or more prescribed medications (in-
cluding over-the-counter medications and dietary sup-
plements); 
‘‘(2) take any ‘high risk’ medications; 
‘‘(3) have 2 or more chronic diseases, as identi-
fied by the Secretary; or 
‘‘(4) have undergone a transition of care, or 
other factors, as determined by the Secretary, that are 
likely to create a high risk of medication-related prob-
lems. 
‘‘(e) CONSULTATION WITH EXPERTS.—In designing 
and implementing MTM services provided under grants or 
contracts awarded under subsection (a), the Secretary shall 
consult with Federal, State, private, public-private, and 
academic entities, pharmacy and pharmacist organiza-
tions, health care organizations, consumer advocates, chron-
ic disease groups, and other stakeholders involved with the 
research, dissemination, and implementation of phar-
macist-delivered MTM services, as the Secretary determines 
appropriate. The Secretary, in collaboration with this 
group, shall determine whether it is possible to incorporate 
rapid cycle process improvement concepts in use in other 
Federal programs that have implemented MTM services.
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‘‘(f) REPORTING TO THE SECRETARY.—An entity that 
receives a grant or contract under subsection (a) shall sub-
mit to the Secretary a report that describes and evaluates, 
as requested by the Secretary, the activities carried out 
under subsection (c), including quality measures endorsed 
by the entity with a contract under section 1890 of the So-
cial Security Act, as determined by the Secretary. 
‘‘(g) EVALUATION AND REPORT.—The Secretary shall 
submit to the relevant committees of Congress a report 
which shall— 
‘‘(1) assess the clinical effectiveness of phar-
macist-provided services under the MTM services pro-
gram, as compared to usual care, including an eval-
uation of whether enrollees maintained better health 
with fewer hospitalizations and emergency room visits 
than similar patients not enrolled in the program; 
‘‘(2) assess changes in overall health care re-
source use by targeted individuals; 
‘‘(3) assess patient and prescriber satisfaction 
with MTM services; 
‘‘(4) assess the impact of patient-cost sharing re-
quirements 
on 
medication 
adherence 
and 
rec-
ommendations for modifications; 
‘‘(5) identify and evaluate other factors that may 
impact clinical and economic outcomes, including de-
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mographic characteristics, clinical characteristics, 
and health services use of the patient, as well as char-
acteristics of the regimen, pharmacy benefit, and 
MTM services provided; and 
‘‘(6) evaluate the extent to which participating 
pharmacists who maintain a dispensing role have a 
conflict of interest in the provision of MTM services, 
and if such conflict is found, provide recommenda-
tions on how such a conflict might be appropriately 
addressed. 
‘‘(h) GRANTS OR CONTRACTS TO FUND DEVELOPMENT 
OF
PERFORMANCE
MEASURES.—The Secretary may, 
through the quality measure development program under 
section 931 of the Public Health Service Act, award grants 
or contracts to eligible entities for the purpose of funding 
the development of performance measures that assess the use 
and effectiveness of medication therapy management serv-
ices.’’. 
SEC. 3504. DESIGN AND IMPLEMENTATION OF REGIONAL-
IZED SYSTEMS FOR EMERGENCY CARE. 
(a) IN GENERAL.—Title XII of the Public Health Serv-
ice Act (42 U.S.C. 300d et seq.) is amended— 
(1) in section 1203—
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(A) in the section heading, by inserting 
‘‘FOR TRAUMA SYSTEMS’’ after ‘‘GRANTS’’; 
and 
(B) in subsection (a), by striking ‘‘Adminis-
trator of the Health Resources and Services Ad-
ministration’’ and inserting ‘‘Assistant Sec-
retary for Preparedness and Response’’; 
(2) by inserting after section 1203 the following: 
‘‘SEC. 1204. COMPETITIVE GRANTS FOR REGIONALIZED SYS-
TEMS FOR EMERGENCY CARE RESPONSE. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Assistant Secretary for Preparedness and Response, shall 
award not fewer than 4 multiyear contracts or competitive 
grants to eligible entities to support pilot projects that de-
sign, implement, and evaluate innovative models of region-
alized, comprehensive, and accountable emergency care and 
trauma systems. 
‘‘(b) ELIGIBLE ENTITY; REGION.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible enti-
ty’ means— 
‘‘(A) a State or a partnership of 1 or more 
States and 1 or more local governments; or 
‘‘(B) an Indian tribe (as defined in section 
4 of the Indian Health Care Improvement Act) 
or a partnership of 1 or more Indian tribes.
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‘‘(2) REGION.—The term ‘region’ means an area 
within a State, an area that lies within multiple 
States, or a similar area (such as a multicounty 
area), as determined by the Secretary. 
‘‘(3) EMERGENCY SERVICES.—The term ‘emer-
gency services’ includes acute, prehospital, and trau-
ma care. 
‘‘(c) PILOT PROJECTS.—The Secretary shall award a 
contract or grant under subsection (a) to an eligible entity 
that proposes a pilot project to design, implement, and 
evaluate an emergency medical and trauma system that— 
‘‘(1) coordinates with public health and safety 
services, emergency medical services, medical facili-
ties, trauma centers, and other entities in a region to 
develop an approach to emergency medical and trau-
ma system access throughout the region, including 9– 
1–1 Public Safety Answering Points and emergency 
medical dispatch; 
‘‘(2) includes a mechanism, such as a regional 
medical direction or transport communications sys-
tem, that operates throughout the region to ensure 
that the patient is taken to the medically appropriate 
facility (whether an initial facility or a higher-level 
facility) in a timely fashion;
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‘‘(3) allows for the tracking of prehospital and 
hospital resources, including inpatient bed capacity, 
emergency department capacity, trauma center capac-
ity, on-call specialist coverage, ambulance diversion 
status, and the coordination of such tracking with re-
gional communications and hospital destination deci-
sions; and 
‘‘(4) 
includes 
a 
consistent 
region-wide 
prehospital, hospital, and interfacility data manage-
ment system that— 
‘‘(A) submits data to the National EMS In-
formation System, the National Trauma Data 
Bank, and others; 
‘‘(B) reports data to appropriate Federal 
and State databanks and registries; and 
‘‘(C) contains information sufficient to 
evaluate key elements of prehospital care, hos-
pital destination decisions, including initial hos-
pital and interfacility decisions, and relevant 
health outcomes of hospital care. 
‘‘(d) APPLICATION.— 
‘‘(1) IN GENERAL.—An eligible entity that seeks 
a contract or grant described in subsection (a) shall 
submit to the Secretary an application at such time 
and in such manner as the Secretary may require.
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‘‘(2) APPLICATION INFORMATION.—Each appli-
cation shall include— 
‘‘(A) an assurance from the eligible entity 
that the proposed system— 
‘‘(i) has been coordinated with the ap-
plicable State Office of Emergency Medical 
Services (or equivalent State office); 
‘‘(ii) includes consistent indirect and 
direct medical oversight of prehospital, hos-
pital, and interfacility transport throughout 
the region; 
‘‘(iii) coordinates prehospital treat-
ment and triage, hospital destination, and 
interfacility transport throughout the re-
gion; 
‘‘(iv) includes a categorization or des-
ignation system for special medical facili-
ties throughout the region that is integrated 
with transport and destination protocols; 
‘‘(v) includes a regional medical direc-
tion, patient tracking, and resource alloca-
tion system that supports day-to-day emer-
gency care and surge capacity and is inte-
grated with other components of the na-
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tional and State emergency preparedness 
system; and 
‘‘(vi) addresses pediatric concerns re-
lated to integration, planning, prepared-
ness, and coordination of emergency med-
ical services for infants, children and ado-
lescents; and 
‘‘(B) such other information as the Sec-
retary may require. 
‘‘(e) REQUIREMENT OF MATCHING FUNDS.— 
‘‘(1) IN GENERAL.—The Secretary may not make 
a grant under this section unless the State (or con-
sortia of States) involved agrees, with respect to the 
costs to be incurred by the State (or consortia) in car-
rying out the purpose for which such grant was made, 
to make available non-Federal contributions (in cash 
or in kind under paragraph (2)) toward such costs in 
an amount equal to not less than $1 for each $3 of 
Federal funds provided in the grant. Such contribu-
tions may be made directly or through donations from 
public or private entities. 
‘‘(2) NON-FEDERAL CONTRIBUTIONS.—Non-Fed-
eral contributions required in paragraph (1) may be 
in cash or in kind, fairly evaluated, including equip-
ment or services (and excluding indirect or overhead
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costs). Amounts provided by the Federal Government, 
or services assisted or subsidized to any significant 
extent by the Federal Government, may not be in-
cluded in determining the amount of such non-Fed-
eral contributions. 
‘‘(f) PRIORITY.—The Secretary shall give priority for 
the award of the contracts or grants described in subsection 
(a) to any eligible entity that serves a population in a 
medically underserved area (as defined in section 
330(b)(3)). 
‘‘(g) REPORT.—Not later than 90 days after the com-
pletion of a pilot project under subsection (a), the recipient 
of such contract or grant described in shall submit to the 
Secretary a report containing the results of an evaluation 
of the program, including an identification of— 
‘‘(1) the impact of the regional, accountable 
emergency care and trauma system on patient health 
outcomes for various critical care categories, such as 
trauma, stroke, cardiac emergencies, neurological 
emergencies, and pediatric emergencies; 
‘‘(2) the system characteristics that contribute to 
the effectiveness and efficiency of the program (or lack 
thereof);
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‘‘(3) methods of assuring the long-term financial 
sustainability of the emergency care and trauma sys-
tem; 
‘‘(4) the State and local legislation necessary to 
implement and to maintain the system; 
‘‘(5) the barriers to developing regionalized, ac-
countable emergency care and trauma systems, as 
well as the methods to overcome such barriers; and 
‘‘(6) recommendations on the utilization of avail-
able funding for future regionalization efforts. 
‘‘(h) DISSEMINATION
OF FINDINGS.—The Secretary 
shall, as appropriate, disseminate to the public and to the 
appropriate Committees of the Congress, the information 
contained in a report made under subsection (g).’’; and 
(3) in section 1232— 
(A) in subsection (a), by striking ‘‘appro-
priated’’ and all that follows through the period 
at 
the 
end 
and 
inserting 
‘‘appropriated 
$24,000,000 for each of fiscal years 2010 through 
2014.’’; and 
(B) by inserting after subsection (c) the fol-
lowing: 
‘‘(d) AUTHORITY.—For the purpose of carrying out 
parts A through C, beginning on the date of enactment of 
the Patient Protection and Affordable Care Act, the Sec-
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retary shall transfer authority in administering grants and 
related authorities under such parts from the Administrator 
of the Health Resources and Services Administration to the 
Assistant Secretary for Preparedness and Response.’’. 
(b) SUPPORT
FOR
EMERGENCY
MEDICINE
RE-
SEARCH.—Part H of title IV of the Public Health Service 
Act (42 U.S.C. 289 et seq.) is amended by inserting after 
the section 498C the following: 
‘‘SEC. 498D. SUPPORT FOR EMERGENCY MEDICINE RE-
SEARCH. 
‘‘(a) EMERGENCY MEDICAL RESEARCH.—The Sec-
retary shall support Federal programs administered by the 
National Institutes of Health, the Agency for Healthcare 
Research and Quality, the Health Resources and Services 
Administration, the Centers for Disease Control and Pre-
vention, and other agencies involved in improving the emer-
gency care system to expand and accelerate research in 
emergency medical care systems and emergency medicine, 
including— 
‘‘(1) the basic science of emergency medicine; 
‘‘(2) the model of service delivery and the compo-
nents of such models that contribute to enhanced pa-
tient health outcomes; 
‘‘(3) the translation of basic scientific research 
into improved practice; and
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‘‘(4) the development of timely and efficient de-
livery of health services. 
‘‘(b) PEDIATRIC EMERGENCY MEDICAL RESEARCH.— 
The Secretary shall support Federal programs administered 
by the National Institutes of Health, the Agency for 
Healthcare Research and Quality, the Health Resources and 
Services Administration, the Centers for Disease Control 
and Prevention, and other agencies to coordinate and ex-
pand research in pediatric emergency medical care systems 
and pediatric emergency medicine, including— 
‘‘(1) an examination of the gaps and opportuni-
ties in pediatric emergency care research and a strat-
egy for the optimal organization and funding of such 
research; 
‘‘(2) the role of pediatric emergency services as 
an integrated component of the overall health system; 
‘‘(3) system-wide pediatric emergency care plan-
ning, preparedness, coordination, and funding; 
‘‘(4) pediatric training in professional edu-
cation; and 
‘‘(5) research in pediatric emergency care, spe-
cifically on the efficacy, safety, and health outcomes 
of medications used for infants, children, and adoles-
cents in emergency care settings in order to improve 
patient safety.
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‘‘(c) IMPACT RESEARCH.—The Secretary shall support 
research to determine the estimated economic impact of, and 
savings that result from, the implementation of coordinated 
emergency care systems. 
‘‘(d) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 2010 
through 2014.’’. 
SEC. 3505. TRAUMA CARE CENTERS AND SERVICE AVAIL-
ABILITY. 
(a) TRAUMA CARE CENTERS.— 
(1) GRANTS FOR TRAUMA CARE CENTERS.—Sec-
tion 1241 of the Public Health Service Act (42 U.S.C. 
300d–41) is amended by striking subsections (a) and 
(b) and inserting the following: 
‘‘(a) IN GENERAL.—The Secretary shall establish 3 
programs to award grants to qualified public, nonprofit In-
dian Health Service, Indian tribal, and urban Indian trau-
ma centers— 
‘‘(1) to assist in defraying substantial uncom-
pensated care costs; 
‘‘(2) to further the core missions of such trauma 
centers, including by addressing costs associated with 
patient stabilization and transfer, trauma education 
and outreach, coordination with local and regional
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trauma systems, essential personnel and other fixed 
costs, and expenses associated with employee and non- 
employee physician services; and 
‘‘(3) to provide emergency relief to ensure the 
continued and future availability of trauma services. 
‘‘(b) MINIMUM QUALIFICATIONS
OF TRAUMA CEN-
TERS.— 
‘‘(1) PARTICIPATION IN TRAUMA CARE SYSTEM 
OPERATING UNDER CERTAIN PROFESSIONAL GUIDE-
LINES.—Except as provided in paragraph (2), the 
Secretary may not award a grant to a trauma center 
under subsection (a) unless the trauma center is a 
participant in a trauma system that substantially 
complies with section 1213. 
‘‘(2) EXEMPTION.—Paragraph (1) shall not 
apply to trauma centers that are located in States 
with no existing trauma care system. 
‘‘(3) QUALIFICATION FOR SUBSTANTIAL UNCOM-
PENSATED CARE COSTS.—The Secretary shall award 
substantial uncompensated care grants under sub-
section (a)(1) only to trauma centers meeting at least 
1 of the criteria in 1 of the following 3 categories: 
‘‘(A) CATEGORY A.—The criteria for cat-
egory A are as follows:
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‘‘(i) At least 40 percent of the visits in 
the emergency department of the hospital in 
which the trauma center is located were 
charity or self-pay patients. 
‘‘(ii) At least 50 percent of the visits in 
such emergency department were Medicaid 
(under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.)) and charity and 
self-pay patients combined. 
‘‘(B) CATEGORY B.—The criteria for cat-
egory B are as follows: 
‘‘(i) At least 35 percent of the visits in 
the emergency department were charity or 
self-pay patients. 
‘‘(ii) At least 50 percent of the visits in 
the emergency department were Medicaid 
and charity and self-pay patients combined. 
‘‘(C) CATEGORY
C.—The criteria for cat-
egory C are as follows: 
‘‘(i) At least 20 percent of the visits in 
the emergency department were charity or 
self-pay patients. 
‘‘(ii) At least 30 percent of the visits in 
the emergency department were Medicaid 
and charity and self-pay patients combined.
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‘‘(4) 
TRAUMA
CENTERS
IN
1115
WAIVER 
STATES.—Notwithstanding paragraph (3), the Sec-
retary may award a substantial uncompensated care 
grant to a trauma center under subsection (a)(1) if 
the trauma center qualifies for funds under a Low In-
come Pool or Safety Net Care Pool established through 
a waiver approved under section 1115 of the Social 
Security Act (42 U.S.C. 1315). 
‘‘(5) DESIGNATION.—The Secretary may not 
award a grant to a trauma center unless such trauma 
center is verified by the American College of Surgeons 
or designated by an equivalent State or local agency. 
‘‘(c) ADDITIONAL
REQUIREMENTS.—The Secretary 
may not award a grant to a trauma center under subsection 
(a)(1) unless such trauma center— 
‘‘(1) submits to the Secretary a plan satisfactory 
to the Secretary that demonstrates a continued com-
mitment to serving trauma patients regardless of 
their ability to pay; and 
‘‘(2) has policies in place to assist patients who 
cannot pay for part or all of the care they receive, in-
cluding a sliding fee scale, and to ensure fair billing 
and collection practices.’’. 
(2) CONSIDERATIONS IN MAKING GRANTS.—Sec-
tion 1242 of the Public Health Service Act (42 U.S.C.
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300d–42) is amended by striking subsections (a) and 
(b) and inserting the following: 
‘‘(a) 
SUBSTANTIAL
UNCOMPENSATED
CARE 
AWARDS.— 
‘‘(1) IN GENERAL.—The Secretary shall establish 
an award basis for each eligible trauma center for 
grants under section 1241(a)(1) according to the per-
centage described in paragraph (2), subject to the re-
quirements of section 1241(b)(3). 
‘‘(2) PERCENTAGES.—The applicable percentages 
are as follows: 
‘‘(A) With respect to a category A trauma 
center, 100 percent of the uncompensated care 
costs. 
‘‘(B) With respect to a category B trauma 
center, not more than 75 percent of the uncom-
pensated care costs. 
‘‘(C) With respect to a category C trauma 
center, not more than 50 percent of the uncom-
pensated care costs. 
‘‘(b) CORE MISSION AWARDS.— 
‘‘(1) IN GENERAL.—In awarding grants under 
section 1241(a)(2), the Secretary shall—
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‘‘(A) reserve 25 percent of the amount allo-
cated for core mission awards for Level III and 
Level IV trauma centers; and 
‘‘(B) reserve 25 percent of the amount allo-
cated for core mission awards for large urban 
Level I and II trauma centers— 
‘‘(i) that have at least 1 graduate med-
ical education fellowship in trauma or 
trauma related specialties for which de-
mand is exceeding supply; 
‘‘(ii) for which— 
‘‘(I) annual uncompensated care 
costs exceed $10,000,000; or 
‘‘(II) at least 20 percent of emer-
gency department visits are charity or 
self-pay or Medicaid patients; and 
‘‘(iii) that are not eligible for substan-
tial uncompensated care awards under sec-
tion 1241(a)(1). 
‘‘(c) EMERGENCY
AWARDS.—In awarding grants 
under section 1241(a)(3), the Secretary shall— 
‘‘(1) give preference to any application submitted 
by a trauma center that provides trauma care in a 
geographic area in which the availability of trauma 
care has significantly decreased or will significantly
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decrease if the center is forced to close or downgrade 
service or growth in demand for trauma services ex-
ceeds capacity; and 
‘‘(2) reallocate any emergency awards funds not 
obligated due to insufficient, or a lack of qualified, 
applications to the significant uncompensated care 
award program.’’. 
(3) CERTAIN AGREEMENTS.—Section 1243 of the 
Public Health Service Act (42 U.S.C. 300d–43) is 
amended by striking subsections (a), (b), and (c) and 
inserting the following: 
‘‘(a) MAINTENANCE
OF FINANCIAL SUPPORT.—The 
Secretary may require a trauma center receiving a grant 
under section 1241(a) to maintain access to trauma services 
at comparable levels to the prior year during the grant pe-
riod. 
‘‘(b) TRAUMA CARE REGISTRY.—The Secretary may 
require the trauma center receiving a grant under section 
1241(a) to provide data to a national and centralized reg-
istry of trauma cases, in accordance with guidelines devel-
oped by the American College of Surgeons, and as the Sec-
retary may otherwise require.’’. 
(4) GENERAL PROVISIONS.—Section 1244 of the 
Public Health Service Act (42 U.S.C. 300d–44) is
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amended by striking subsections (a), (b), and (c) and 
inserting the following: 
‘‘(a) APPLICATION.—The Secretary may not award a 
grant to a trauma center under section 1241(a) unless such 
center submits an application for the grant to the Secretary 
and the application is in such form, is made in such man-
ner, and contains such agreements, assurances, and infor-
mation as the Secretary determines to be necessary to carry 
out this part. 
‘‘(b) LIMITATION ON DURATION OF SUPPORT.—The pe-
riod during which a trauma center receives payments under 
a grant under section 1241(a)(3) shall be for 3 fiscal years, 
except that the Secretary may waive such requirement for 
a center and authorize such center to receive such payments 
for 1 additional fiscal year. 
‘‘(c) LIMITATION ON AMOUNT OF GRANT.—Notwith-
standing section 1242(a), a grant under section 1241 may 
not be made in an amount exceeding $2,000,000 for each 
fiscal year. 
‘‘(d) ELIGIBILITY.—Except as provided in section 
1242(b)(1)(B)(iii), acquisition of, or eligibility for, a grant 
under section 1241(a) shall not preclude a trauma center 
from being eligible for other grants described in such sec-
tion.
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‘‘(e) FUNDING DISTRIBUTION.—Of the total amount 
appropriated for a fiscal year under section 1245, 70 per-
cent shall be used for substantial uncompensated care 
awards under section 1241(a)(1), 20 percent shall be used 
for core mission awards under section 1241(a)(2), and 10 
percent shall be used for emergency awards under section 
1241(a)(3). 
‘‘(f) MINIMUM ALLOWANCE.—Notwithstanding sub-
section (e), if the amount appropriated for a fiscal year 
under section 1245 is less than $25,000,000, all available 
funding for such fiscal year shall be used for substantial 
uncompensated care awards under section 1241(a)(1). 
‘‘(g) SUBSTANTIAL UNCOMPENSATED CARE AWARD 
DISTRIBUTION
AND
PROPORTIONAL
SHARE.—Notwith-
standing section 1242(a), of the amount appropriated for 
substantial uncompensated care grants for a fiscal year, the 
Secretary shall— 
‘‘(1) make available— 
‘‘(A) 50 percent of such funds for category 
A trauma center grantees; 
‘‘(B) 35 percent of such funds for category 
B trauma center grantees; and 
‘‘(C) 15 percent of such funds for category 
C trauma center grantees; and
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‘‘(2) provide available funds within each cat-
egory in a manner proportional to the award basis 
specified in section 1242(a)(2) to each eligible trauma 
center. 
‘‘(h) REPORT.—Beginning 2 years after the date of en-
actment of the Patient Protection and Affordable Care Act, 
and every 2 years thereafter, the Secretary shall biennially 
report to Congress regarding the status of the grants made 
under section 1241 and on the overall financial stability 
of trauma centers.’’. 
(5) AUTHORIZATION OF APPROPRIATIONS.—Sec-
tion 1245 of the Public Health Service Act (42 U.S.C. 
300d–45) is amended to read as follows: 
‘‘SEC. 1245. AUTHORIZATION OF APPROPRIATIONS. 
‘‘For the purpose of carrying out this part, there are 
authorized to be appropriated $100,000,000 for fiscal year 
2009, and such sums as may be necessary for each of fiscal 
years 2010 through 2015. Such authorization of appropria-
tions is in addition to any other authorization of appro-
priations or amounts that are available for such purpose.’’. 
(6) DEFINITION.—Part D of title XII of the Pub-
lic Health Service Act (42 U.S.C. 300d–41 et seq.) is 
amended by adding at the end the following:
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‘‘SEC. 1246. DEFINITION. 
‘‘In this part, the term ‘uncompensated care costs’ 
means unreimbursed costs from serving self-pay, charity, 
or Medicaid patients, without regard to payment under sec-
tion 1923 of the Social Security Act, all of which are attrib-
utable to emergency care and trauma care, including costs 
related to subsequent inpatient admissions to the hospital.’’. 
(b) TRAUMA SERVICE AVAILABILITY.—Title XII of the 
Public Health Service Act (42 U.S.C. 300d et seq.) is 
amended by adding at the end the following: 
‘‘PART H—TRAUMA SERVICE AVAILABILITY 
‘‘SEC. 1281. GRANTS TO STATES. 
‘‘(a) ESTABLISHMENT.—To promote universal access 
to trauma care services provided by trauma centers and 
trauma-related physician specialties, the Secretary shall 
provide funding to States to enable such States to award 
grants to eligible entities for the purposes described in this 
section. 
‘‘(b) AWARDING OF GRANTS BY STATES.—Each State 
may award grants to eligible entities within the State for 
the purposes described in subparagraph (d). 
‘‘(c) ELIGIBILITY.— 
‘‘(1) IN GENERAL.—To be eligible to receive a 
grant under subsection (b) an entity shall— 
‘‘(A) be—
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‘‘(i) a public or nonprofit trauma cen-
ter or consortium thereof that meets that re-
quirements of paragraphs (1), (2), and (5) 
of section 1241(b); 
‘‘(ii) a safety net public or nonprofit 
trauma center that meets the requirements 
of paragraphs (1) through (5) of section 
1241(b); or 
‘‘(iii) a hospital in an underserved 
area (as defined by the State) that seeks to 
establish new trauma services; and 
‘‘(B) submit to the State an application at 
such time, in such manner, and containing such 
information as the State may require. 
‘‘(2) LIMITATION.—A State shall use at least 40 
percent of the amount available to the State under 
this part for a fiscal year to award grants to safety 
net trauma centers described in paragraph (1)(A)(ii). 
‘‘(d) USE OF FUNDS.—The recipient of a grant under 
subsection (b) shall carry out 1 or more of the following 
activities consistent with subsection (b): 
‘‘(1) Providing trauma centers with funding to 
support physician compensation in trauma-related 
physician specialties where shortages exist in the re-
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gion involved, with priority provided to safety net 
trauma centers described in subsection (c)(1)(A)(ii). 
‘‘(2) Providing for individual safety net trauma 
center fiscal stability and costs related to having serv-
ice that is available 24 hours a day, 7 days a week, 
with priority provided to safety net trauma centers 
described in subsection (c)(1)(A)(ii) located in urban, 
border, and rural areas. 
‘‘(3) Reducing trauma center overcrowding at 
specific trauma centers related to throughput of trau-
ma patients. 
‘‘(4) Establishing new trauma services in under-
served areas as defined by the State. 
‘‘(5) Enhancing collaboration between trauma 
centers and other hospitals and emergency medical 
services personnel related to trauma service avail-
ability. 
‘‘(6) Making capital improvements to enhance 
access and expedite trauma care, including providing 
helipads and associated safety infrastructure. 
‘‘(7) Enhancing trauma surge capacity at spe-
cific trauma centers. 
‘‘(8) Ensuring expedient receipt of trauma pa-
tients transported by ground or air to the appropriate 
trauma center.
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‘‘(9) Enhancing interstate trauma center collabo-
ration. 
‘‘(e) LIMITATION.— 
‘‘(1) IN GENERAL.—A State may use not more 
than 20 percent of the amount available to the State 
under this part for a fiscal year for administrative 
costs associated with awarding grants and related 
costs. 
‘‘(2) MAINTENANCE OF EFFORT.—The Secretary 
may not provide funding to a State under this part 
unless the State agrees that such funds will be used 
to supplement and not supplant State funding other-
wise available for the activities and costs described in 
this part. 
‘‘(f) DISTRIBUTION OF FUNDS.—The following shall 
apply with respect to grants provided in this part: 
‘‘(1) LESS THAN $10,000,000.—If the amount of 
appropriations for this part in a fiscal year is less 
than $10,000,000, the Secretary shall divide such 
funding evenly among only those States that have 1 
or more trauma centers eligible for funding under sec-
tion 1241(b)(3)(A). 
‘‘(2) LESS THAN $20,000,000.—If the amount of 
appropriations in a fiscal year is less than 
$20,000,000, the Secretary shall divide such funding
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evenly among only those States that have 1 or more 
trauma centers eligible for funding under subpara-
graphs (A) and (B) of section 1241(b)(3). 
‘‘(3) LESS THAN $30,000,000.—If the amount of 
appropriations for this part in a fiscal year is less 
than $30,000,000, the Secretary shall divide such 
funding evenly among only those States that have 1 
or more trauma centers eligible for funding under sec-
tion 1241(b)(3). 
‘‘(4) $30,000,000 OR MORE.—If the amount of 
appropriations for this part in a fiscal year is 
$30,000,000 or more, the Secretary shall divide such 
funding evenly among all States. 
‘‘SEC. 1282. AUTHORIZATION OF APPROPRIATIONS. 
‘‘For the purpose of carrying out this part, there is 
authorized to be appropriated $100,000,000 for each of fis-
cal years 2010 through 2015.’’. 
SEC. 3506. PROGRAM TO FACILITATE SHARED DECISION-
MAKING. 
Part D of title IX of the Public Health Service Act, 
as amended by section 3503, is further amended by adding 
at the end the following:
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‘‘SEC. 936. PROGRAM TO FACILITATE SHARED DECISION-
MAKING. 
‘‘(a) PURPOSE.—The purpose of this section is to fa-
cilitate collaborative processes between patients, caregivers 
or authorized representatives, and clinicians that engages 
the patient, caregiver or authorized representative in deci-
sionmaking, provides patients, caregivers or authorized rep-
resentatives with information about trade-offs among treat-
ment options, and facilitates the incorporation of patient 
preferences and values into the medical plan. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) PATIENT DECISION AID.—The term ‘patient 
decision aid’ means an educational tool that helps pa-
tients, caregivers or authorized representatives under-
stand and communicate their beliefs and preferences 
related to their treatment options, and to decide with 
their health care provider what treatments are best for 
them based on their treatment options, scientific evi-
dence, circumstances, beliefs, and preferences. 
‘‘(2) PREFERENCE SENSITIVE CARE.—The term 
‘preference sensitive care’ means medical care for 
which the clinical evidence does not clearly support 
one treatment option such that the appropriate course 
of treatment depends on the values of the patient or 
the preferences of the patient, caregivers or authorized 
representatives regarding the benefits, harms and sci-
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entific evidence for each treatment option, the use of 
such care should depend on the informed patient 
choice among clinically appropriate treatment op-
tions. 
‘‘(c) ESTABLISHMENT OF INDEPENDENT STANDARDS 
FOR PATIENT DECISION AIDS FOR PREFERENCE SENSITIVE 
CARE.— 
‘‘(1) CONTRACT
WITH
ENTITY
TO
ESTABLISH 
STANDARDS AND CERTIFY PATIENT DECISION AIDS.— 
‘‘(A) IN GENERAL.—For purposes of sup-
porting consensus-based standards for patient de-
cision aids for preference sensitive care and a 
certification process for patient decision aids for 
use in the Federal health programs and by other 
interested parties, the Secretary shall have in ef-
fect a contract with the entity with a contract 
under section 1890 of the Social Security Act. 
Such contract shall provide that the entity per-
form the duties described in paragraph (2). 
‘‘(B) TIMING
FOR
FIRST
CONTRACT.—As 
soon as practicable after the date of the enact-
ment of this section, the Secretary shall enter 
into the first contract under subparagraph (A). 
‘‘(C) PERIOD
OF
CONTRACT.—A contract 
under subparagraph (A) shall be for a period of
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18 months (except such contract may be renewed 
after a subsequent bidding process). 
‘‘(2) DUTIES.—The following duties are de-
scribed in this paragraph: 
‘‘(A) DEVELOP AND IDENTIFY STANDARDS 
FOR PATIENT DECISION AIDS.—The entity shall 
synthesize evidence and convene a broad range of 
experts and key stakeholders to develop and iden-
tify consensus-based standards to evaluate pa-
tient decision aids for preference sensitive care. 
‘‘(B) ENDORSE PATIENT DECISION AIDS.— 
The entity shall review patient decision aids and 
develop a certification process whether patient 
decision aids meet the standards developed and 
identified under subparagraph (A). The entity 
shall give priority to the review and certification 
of patient decision aids for preference sensitive 
care. 
‘‘(d) PROGRAM TO DEVELOP, UPDATE AND PATIENT 
DECISION AIDS TO ASSIST HEALTH CARE PROVIDERS AND 
PATIENTS.— 
‘‘(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Director, and in coordination with heads 
of other relevant agencies, such as the Director of the 
Centers for Disease Control and Prevention and the
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Director of the National Institutes of Health, shall es-
tablish a program to award grants or contracts— 
‘‘(A) to develop, update, and produce pa-
tient decision aids for preference sensitive care to 
assist health care providers in educating pa-
tients, caregivers, and authorized representatives 
concerning the relative safety, relative effective-
ness (including possible health outcomes and im-
pact on functional status), and relative cost of 
treatment or, where appropriate, palliative care 
options; 
‘‘(B) to test such materials to ensure such 
materials are balanced and evidence based in 
aiding health care providers and patients, care-
givers, and authorized representatives to make 
informed decisions about patient care and can be 
easily incorporated into a broad array of prac-
tice settings; and 
‘‘(C) to educate providers on the use of such 
materials, including through academic curricula. 
‘‘(2) REQUIREMENTS
FOR
PATIENT
DECISION 
AIDS.—Patient decision aids developed and produced 
pursuant to a grant or contract under paragraph 
(1)—
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‘‘(A) shall be designed to engage patients, 
caregivers, and authorized representatives in in-
formed decisionmaking with health care pro-
viders; 
‘‘(B) shall present up-to-date clinical evi-
dence about the risks and benefits of treatment 
options in a form and manner that is age-appro-
priate and can be adapted for patients, care-
givers, and authorized representatives from a va-
riety of cultural and educational backgrounds to 
reflect the varying needs of consumers and di-
verse levels of health literacy; 
‘‘(C) shall, where appropriate, explain why 
there is a lack of evidence to support one treat-
ment option over another; and 
‘‘(D) shall address health care decisions 
across the age span, including those affecting 
vulnerable populations including children. 
‘‘(3) DISTRIBUTION.—The Director shall ensure 
that patient decision aids produced with grants or 
contracts under this section are available to the pub-
lic. 
‘‘(4) NONDUPLICATION OF EFFORTS.—The Direc-
tor shall ensure that the activities under this section 
of the Agency and other agencies, including the Cen-
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ters for Disease Control and Prevention and the Na-
tional Institutes of Health, are free of unnecessary du-
plication of effort. 
‘‘(e) GRANTS TO SUPPORT SHARED DECISIONMAKING 
IMPLEMENTATION.— 
‘‘(1) IN GENERAL.—The Secretary shall establish 
a program to provide for the phased-in development, 
implementation, and evaluation of shared decision-
making using patient decision aids to meet the objec-
tive of improving the understanding of patients of 
their medical treatment options. 
‘‘(2) SHARED DECISIONMAKING RESOURCE CEN-
TERS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide grants for the establishment and support 
of Shared Decisionmaking Resource Centers (re-
ferred to in this subsection as ‘Centers’) to pro-
vide technical assistance to providers and to de-
velop and disseminate best practices and other 
information to support and accelerate adoption, 
implementation, and effective use of patient deci-
sion aids and shared decisionmaking by pro-
viders. 
‘‘(B) OBJECTIVES.—The objective of a Cen-
ter is to enhance and promote the adoption of
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patient decision aids and shared decisionmaking 
through— 
‘‘(i) providing assistance to eligible 
providers with the implementation and ef-
fective use of, and training on, patient deci-
sion aids; and 
‘‘(ii) the dissemination of best practices 
and research on the implementation and ef-
fective use of patient decision aids. 
‘‘(3) SHARED
DECISIONMAKING
PARTICIPATION 
GRANTS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide grants to health care providers for the 
development and implementation of shared deci-
sionmaking techniques and to assess the use of 
such techniques. 
‘‘(B) PREFERENCE.—In order to facilitate 
the use of best practices, the Secretary shall pro-
vide a preference in making grants under this 
subsection to health care providers who partici-
pate in training by Shared Decisionmaking Re-
source Centers or comparable training. 
‘‘(C) LIMITATION.—Funds under this para-
graph shall not be used to purchase or imple-
ment use of patient decision aids other than
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those certified under the process identified in 
subsection (c). 
‘‘(4) GUIDANCE.—The Secretary may issue guid-
ance to eligible grantees under this subsection on the 
use of patient decision aids. 
‘‘(f) FUNDING.—For purposes of carrying out this sec-
tion there are authorized to be appropriated such sums as 
may be necessary for fiscal year 2010 and each subsequent 
fiscal year.’’. 
SEC. 3507. PRESENTATION OF PRESCRIPTION DRUG BEN-
EFIT AND RISK INFORMATION. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’), acting through the Commissioner of Food and 
Drugs, shall determine whether the addition of quantitative 
summaries of the benefits and risks of prescription drugs 
in a standardized format (such as a table or drug facts box) 
to the promotional labeling or print advertising of such 
drugs would improve health care decisionmaking by clini-
cians and patients and consumers. 
(b) REVIEW AND CONSULTATION.—In making the de-
termination under subsection (a), the Secretary shall review 
all available scientific evidence and research on decision-
making and social and cognitive psychology and consult 
with drug manufacturers, clinicians, patients and con-
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sumers, experts in health literacy, representatives of racial 
and ethnic minorities, and experts in women’s and pedi-
atric health. 
(c) REPORT.—Not later than 1 year after the date of 
enactment of this Act, the Secretary shall submit to Con-
gress a report that provides— 
(1) the determination by the Secretary under 
subsection (a); and 
(2) the reasoning and analysis underlying that 
determination. 
(d) AUTHORITY.—If the Secretary determines under 
subsection (a) that the addition of quantitative summaries 
of the benefits and risks of prescription drugs in a stand-
ardized format (such as a table or drug facts box) to the 
promotional labeling or print advertising of such drugs 
would improve health care decisionmaking by clinicians 
and patients and consumers, then the Secretary, not later 
than 3 years after the date of submission of the report under 
subsection (c), shall promulgate proposed regulations as 
necessary to implement such format. 
(e) CLARIFICATION.—Nothing in this section shall be 
construed to restrict the existing authorities of the Secretary 
with respect to benefit and risk information.
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SEC. 3508. DEMONSTRATION PROGRAM TO INTEGRATE 
QUALITY IMPROVEMENT AND PATIENT SAFE-
TY TRAINING INTO CLINICAL EDUCATION OF 
HEALTH PROFESSIONALS. 
(a) IN GENERAL.—The Secretary may award grants 
to eligible entities or consortia under this section to carry 
out demonstration projects to develop and implement aca-
demic curricula that integrates quality improvement and 
patient safety in the clinical education of health profes-
sionals. Such awards shall be made on a competitive basis 
and pursuant to peer review. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity or consortium shall— 
(1) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require; 
(2) be or include— 
(A) a health professions school; 
(B) a school of public health; 
(C) a school of social work; 
(D) a school of nursing; 
(E) a school of pharmacy; 
(F) an institution with a graduate medical 
education program; or 
(G) a school of health care administration;
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(3) collaborate in the development of curricula 
described in subsection (a) with an organization that 
accredits such school or institution; 
(4) provide for the collection of data regarding 
the effectiveness of the demonstration project; and 
(5) provide matching funds in accordance with 
subsection (c). 
(c) MATCHING FUNDS.— 
(1) IN GENERAL.—The Secretary may award a 
grant to an entity or consortium under this section 
only if the entity or consortium agrees to make avail-
able non-Federal contributions toward the costs of the 
program to be funded under the grant in an amount 
that is not less than $1 for each $5 of Federal funds 
provided under the grant. 
(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions under paragraph 
(1) may be in cash or in-kind, fairly evaluated, in-
cluding equipment or services. Amounts provided by 
the Federal Government, or services assisted or sub-
sidized to any significant extent by the Federal Gov-
ernment, may not be included in determining the 
amount of such contributions. 
(d) EVALUATION.—The Secretary shall take such ac-
tion as may be necessary to evaluate the projects funded
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under this section and publish, make publicly available, 
and disseminate the results of such evaluations on as wide 
a basis as is practicable. 
(e) REPORTS.—Not later than 2 years after the date 
of enactment of this section, and annually thereafter, the 
Secretary shall submit to the Committee on Health, Edu-
cation, Labor, and Pensions and the Committee on Finance 
of the Senate and the Committee on Energy and Commerce 
and the Committee on Ways and Means of the House of 
Representatives a report that— 
(1) describes the specific projects supported 
under this section; and 
(2) contains recommendations for Congress based 
on the evaluation conducted under subsection (d). 
SEC. 3509. IMPROVING WOMEN’S HEALTH. 
(a) HEALTH
AND HUMAN SERVICES OFFICE
ON 
WOMEN’S HEALTH.— 
(1) ESTABLISHMENT.—Part A of title II of the 
Public Health Service Act (42 U.S.C. 202 et seq.) is 
amended by adding at the end the following: 
‘‘SEC. 229. HEALTH AND HUMAN SERVICES OFFICE ON WOM-
EN’S HEALTH. 
‘‘(a) ESTABLISHMENT OF OFFICE.—There is estab-
lished within the Office of the Secretary, an Office on Wom-
en’s Health (referred to in this section as the ‘Office’). The
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Office shall be headed by a Deputy Assistant Secretary for 
Women’s Health who may report to the Secretary. 
‘‘(b) DUTIES.—The Secretary, acting through the Of-
fice, with respect to the health concerns of women, shall— 
‘‘(1) establish short-range and long-range goals 
and objectives within the Department of Health and 
Human Services and, as relevant and appropriate, 
coordinate with other appropriate offices on activities 
within the Department that relate to disease preven-
tion, health promotion, service delivery, research, and 
public and health care professional education, for 
issues of particular concern to women throughout 
their lifespan; 
‘‘(2) provide expert advice and consultation to 
the Secretary concerning scientific, legal, ethical, and 
policy issues relating to women’s health; 
‘‘(3) monitor the Department of Health and 
Human Services’ offices, agencies, and regional ac-
tivities regarding women’s health and identify needs 
regarding the coordination of activities, including in-
tramural and extramural multidisciplinary activi-
ties; 
‘‘(4) establish a Department of Health and 
Human Services Coordinating Committee on Wom-
en’s Health, which shall be chaired by the Deputy As-
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sistant Secretary for Women’s Health and composed 
of senior level representatives from each of the agen-
cies and offices of the Department of Health and 
Human Services; 
‘‘(5) establish a National Women’s Health Infor-
mation Center to— 
‘‘(A) facilitate the exchange of information 
regarding matters relating to health information, 
health promotion, preventive health services, re-
search advances, and education in the appro-
priate use of health care; 
‘‘(B) facilitate access to such information; 
‘‘(C) assist in the analysis of issues and 
problems relating to the matters described in this 
paragraph; and 
‘‘(D) provide technical assistance with re-
spect to the exchange of information (including 
facilitating the development of materials for such 
technical assistance); 
‘‘(6) coordinate efforts to promote women’s health 
programs and policies with the private sector; and 
‘‘(7) through publications and any other means 
appropriate, provide for the exchange of information 
between the Office and recipients of grants, contracts,
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and agreements under subsection (c), and between the 
Office and health professionals and the general public. 
‘‘(c) GRANTS AND CONTRACTS REGARDING DUTIES.— 
‘‘(1) AUTHORITY.—In carrying out subsection 
(b), the Secretary may make grants to, and enter into 
cooperative agreements, contracts, and interagency 
agreements with, public and private entities, agencies, 
and organizations. 
‘‘(2) EVALUATION
AND
DISSEMINATION.—The 
Secretary shall directly or through contracts with 
public and private entities, agencies, and organiza-
tions, provide for evaluations of projects carried out 
with financial assistance provided under paragraph 
(1) and for the dissemination of information devel-
oped as a result of such projects. 
‘‘(d) REPORTS.—Not later than 1 year after the date 
of enactment of this section, and every second year there-
after, the Secretary shall prepare and submit to the appro-
priate committees of Congress a report describing the activi-
ties carried out under this section during the period for 
which the report is being prepared. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for each 
of the fiscal years 2010 through 2014.’’.
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(2) TRANSFER OF FUNCTIONS.—There are trans-
ferred to the Office on Women’s Health (established 
under section 229 of the Public Health Service Act, 
as added by this section), all functions exercised by 
the Office on Women’s Health of the Public Health 
Service prior to the date of enactment of this section, 
including all personnel and compensation authority, 
all delegation and assignment authority, and all re-
maining appropriations. All orders, determinations, 
rules, regulations, permits, agreements, grants, con-
tracts, certificates, licenses, registrations, privileges, 
and other administrative actions that— 
(A) have been issued, made, granted, or al-
lowed to become effective by the President, any 
Federal agency or official thereof, or by a court 
of competent jurisdiction, in the performance of 
functions transferred under this paragraph; and 
(B) are in effect at the time this section 
takes effect, or were final before the date of enact-
ment of this section and are to become effective 
on or after such date, 
shall continue in effect according to their terms until 
modified, terminated, superseded, set aside, or revoked 
in accordance with law by the President, the Sec-
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retary, or other authorized official, a court of com-
petent jurisdiction, or by operation of law. 
(b) CENTERS FOR DISEASE CONTROL AND PREVEN-
TION OFFICE OF WOMEN’S HEALTH.—Part A of title III 
of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following: 
‘‘SEC. 310A. CENTERS FOR DISEASE CONTROL AND PREVEN-
TION OFFICE OF WOMEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Office of the Director of the Centers for Disease Control 
and Prevention, an office to be known as the Office of Wom-
en’s Health (referred to in this section as the ‘Office’). The 
Office shall be headed by a director who shall be appointed 
by the Director of such Centers. 
‘‘(b) PURPOSE.—The Director of the Office shall— 
‘‘(1) report to the Director of the Centers for Dis-
ease Control and Prevention on the current level of 
the Centers’ activity regarding women’s health condi-
tions across, where appropriate, age, biological, and 
sociocultural contexts, in all aspects of the Centers’ 
work, including prevention programs, public and pro-
fessional education, services, and treatment; 
‘‘(2) establish short-range and long-range goals 
and objectives within the Centers for women’s health 
and, as relevant and appropriate, coordinate with
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other appropriate offices on activities within the Cen-
ters that relate to prevention, research, education and 
training, service delivery, and policy development, for 
issues of particular concern to women; 
‘‘(3) identify projects in women’s health that 
should be conducted or supported by the Centers; 
‘‘(4) consult with health professionals, non-
governmental organizations, consumer organizations, 
women’s health professionals, and other individuals 
and groups, as appropriate, on the policy of the Cen-
ters with regard to women; and 
‘‘(5) serve as a member of the Department of 
Health and Human Services Coordinating Committee 
on Women’s Health (established under section 
229(b)(4)). 
‘‘(c) DEFINITION.—As used in this section, the term 
‘women’s health conditions’, with respect to women of all 
age, ethnic, and racial groups, means diseases, disorders, 
and conditions— 
‘‘(1) unique to, significantly more serious for, or 
significantly more prevalent in women; and 
‘‘(2) for which the factors of medical risk or type 
of medical intervention are different for women, or for 
which there is reasonable evidence that indicates that 
such factors or types may be different for women.
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‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for each 
of the fiscal years 2010 through 2014.’’. 
(c) OFFICE OF WOMEN’S HEALTH RESEARCH.—Sec-
tion 486(a) of the Public Health Service Act (42 U.S.C. 
287d(a)) is amended by inserting ‘‘and who shall report 
directly to the Director’’ before the period at the end thereof. 
(d) SUBSTANCE ABUSE AND MENTAL HEALTH SERV-
ICES
ADMINISTRATION.—Section 501(f) of the Public 
Health Service Act (42 U.S.C. 290aa(f)) is amended— 
(1) in paragraph (1), by inserting ‘‘who shall re-
port directly to the Administrator’’ before the period; 
(2) by redesignating paragraph (4) as para-
graph (5); and 
(3) by inserting after paragraph (3), the fol-
lowing: 
‘‘(4) OFFICE.—Nothing in this subsection shall 
be construed to preclude the Secretary from estab-
lishing within the Substance Abuse and Mental 
Health 
Administration 
an 
Office 
of 
Women’s 
Health.’’. 
(e) AGENCY FOR HEALTHCARE RESEARCH AND QUAL-
ITY ACTIVITIES REGARDING WOMEN’S HEALTH.—Part C
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of title IX of the Public Health Service Act (42 U.S.C. 299c 
et seq.) is amended— 
(1) by redesignating sections 925 and 926 as sec-
tions 926 and 927, respectively; and 
(2) by inserting after section 924 the following: 
‘‘SEC. 925. ACTIVITIES REGARDING WOMEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Office of the Director, an Office of Women’s Health and 
Gender-Based Research (referred to in this section as the 
‘Office’). The Office shall be headed by a director who shall 
be appointed by the Director of Healthcare and Research 
Quality. 
‘‘(b) PURPOSE.—The official designated under sub-
section (a) shall— 
‘‘(1) report to the Director on the current Agency 
level of activity regarding women’s health, across, 
where appropriate, age, biological, and sociocultural 
contexts, in all aspects of Agency work, including the 
development of evidence reports and clinical practice 
protocols and the conduct of research into patient out-
comes, delivery of health care services, quality of care, 
and access to health care; 
‘‘(2) establish short-range and long-range goals 
and objectives within the Agency for research impor-
tant to women’s health and, as relevant and appro-
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priate, coordinate with other appropriate offices on 
activities within the Agency that relate to health serv-
ices and medical effectiveness research, for issues of 
particular concern to women; 
‘‘(3) identify projects in women’s health that 
should be conducted or supported by the Agency; 
‘‘(4) consult with health professionals, non-
governmental organizations, consumer organizations, 
women’s health professionals, and other individuals 
and groups, as appropriate, on Agency policy with 
regard to women; and 
‘‘(5) serve as a member of the Department of 
Health and Human Services Coordinating Committee 
on Women’s Health (established under section 
229(b)(4)).’’. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for each 
of the fiscal years 2010 through 2014.’’. 
(f) HEALTH RESOURCES AND SERVICES ADMINISTRA-
TION OFFICE OF WOMEN’S HEALTH.—Title VII of the So-
cial Security Act (42 U.S.C. 901 et seq.) is amended by 
adding at the end the following:
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‘‘SEC. 713. OFFICE OF WOMEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—The Secretary shall establish 
within the Office of the Administrator of the Health Re-
sources and Services Administration, an office to be known 
as the Office of Women’s Health. The Office shall be headed 
by a director who shall be appointed by the Administrator. 
‘‘(b) PURPOSE.—The Director of the Office shall— 
‘‘(1) report to the Administrator on the current 
Administration level of activity regarding women’s 
health across, where appropriate, age, biological, and 
sociocultural contexts; 
‘‘(2) establish short-range and long-range goals 
and objectives within the Health Resources and Serv-
ices Administration for women’s health and, as rel-
evant and appropriate, coordinate with other appro-
priate offices on activities within the Administration 
that relate to health care provider training, health 
service delivery, research, and demonstration projects, 
for issues of particular concern to women; 
‘‘(3) identify projects in women’s health that 
should be conducted or supported by the bureaus of 
the Administration; 
‘‘(4) consult with health professionals, non-
governmental organizations, consumer organizations, 
women’s health professionals, and other individuals
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to be appropriated such sums as may be necessary for each 
of the fiscal years 2010 through 2014.’’. 
(g) FOOD AND DRUG ADMINISTRATION OFFICE OF 
WOMEN’S HEALTH.—Chapter X of the Federal Food, Drug, 
and Cosmetic Act (21 U.S.C. 391 et seq.) is amended by 
adding at the end the following: 
‘‘SEC. 1011. OFFICE OF WOMEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Office of the Commissioner, an office to be known as 
the Office of Women’s Health (referred to in this section 
as the ‘Office’). The Office shall be headed by a director who 
shall be appointed by the Commissioner of Food and Drugs. 
‘‘(b) PURPOSE.—The Director of the Office shall— 
‘‘(1) report to the Commissioner of Food and 
Drugs on current Food and Drug Administration (re-
ferred to in this section as the ‘Administration’) levels 
of activity regarding women’s participation in clin-
ical trials and the analysis of data by sex in the test-
ing of drugs, medical devices, and biological products 
across, where appropriate, age, biological, and 
sociocultural contexts; 
‘‘(2) establish short-range and long-range goals 
and objectives within the Administration for issues of 
particular concern to women’s health within the juris-
diction of the Administration, including, where rel-
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evant and appropriate, adequate inclusion of women 
and analysis of data by sex in Administration proto-
cols and policies; 
‘‘(3) provide information to women and health 
care providers on those areas in which differences be-
tween men and women exist; 
‘‘(4) consult with pharmaceutical, biologics, and 
device manufacturers, health professionals with exper-
tise in women’s issues, consumer organizations, and 
women’s health professionals on Administration pol-
icy with regard to women; 
‘‘(5) make annual estimates of funds needed to 
monitor clinical trials and analysis of data by sex in 
accordance with needs that are identified; and 
‘‘(6) serve as a member of the Department of 
Health and Human Services Coordinating Committee 
on Women’s Health (established under section 
229(b)(4) of the Public Health Service Act). 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for each 
of the fiscal years 2010 through 2014.’’. 
(h) NO NEW REGULATORY AUTHORITY.—Nothing in 
this section and the amendments made by this section may
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be construed as establishing regulatory authority or modi-
fying any existing regulatory authority. 
(i) LIMITATION ON TERMINATION.—Notwithstanding 
any other provision of law, a Federal office of women’s 
health (including the Office of Research on Women’s Health 
of the National Institutes of Health) or Federal appointive 
position with primary responsibility over women’s health 
issues (including the Associate Administrator for Women’s 
Services under the Substance Abuse and Mental Health 
Services Administration) that is in existence on the date 
of enactment of this section shall not be terminated, reorga-
nized, or have any of it’s powers or duties transferred unless 
such termination, reorganization, or transfer is approved 
by Congress through the adoption of a concurrent resolution 
of approval. 
(j) RULE OF CONSTRUCTION.—Nothing in this section 
(or the amendments made by this section) shall be construed 
to limit the authority of the Secretary of Health and 
Human Services with respect to women’s health, or with 
respect to activities carried out through the Department of 
Health and Human Services on the date of enactment of 
this section. 
SEC. 3510. PATIENT NAVIGATOR PROGRAM. 
Section 340A of the Public Health Service Act (42 
U.S.C. 256a) is amended—
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(1) by striking subsection (d)(3) and inserting 
the following: 
‘‘(3) LIMITATIONS ON GRANT PERIOD.—In car-
rying out this section, the Secretary shall ensure that 
the total period of a grant does not exceed 4 years.’’; 
(2) in subsection (e), by adding at the end the 
following: 
‘‘(3) MINIMUM CORE PROFICIENCIES.—The Sec-
retary shall not award a grant to an entity under 
this section unless such entity provides assurances 
that patient navigators recruited, assigned, trained, 
or employed using grant funds meet minimum core 
proficiencies, as defined by the entity that submits the 
application, that are tailored for the main focus or 
intervention of the navigator involved.’’; and 
(3) in subsection (m)— 
(A) in paragraph (1), by striking ‘‘and 
$3,500,000 for fiscal year 2010.’’ and inserting 
‘‘$3,500,000 for fiscal year 2010, and such sums 
as may be necessary for each of fiscal years 2011 
through 2015.’’; and 
(B) in paragraph (2), by striking ‘‘2010’’ 
and inserting ‘‘2015’’.
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SEC. 3511. AUTHORIZATION OF APPROPRIATIONS. 
Except where otherwise provided in this subtitle (or 
an amendment made by this subtitle), there is authorized 
to be appropriated such sums as may be necessary to carry 
out this subtitle (and such amendments made by this sub-
title). 
Subtitle G—Protecting and Improv-
ing Guaranteed Medicare Bene-
fits 
SEC. 3601. PROTECTING AND IMPROVING GUARANTEED 
MEDICARE BENEFITS. 
(a) PROTECTING
GUARANTEED
MEDICARE
BENE-
FITS.—Nothing in the provisions of, or amendments made 
by, this Act shall result in a reduction of guaranteed bene-
fits under title XVIII of the Social Security Act. 
(b) ENSURING THAT MEDICARE SAVINGS BENEFIT 
THE
MEDICARE
PROGRAM
AND
MEDICARE
BENE-
FICIARIES.—Savings generated for the Medicare program 
under title XVIII of the Social Security Act under the pro-
visions of, and amendments made by, this Act shall extend 
the solvency of the Medicare trust funds, reduce Medicare 
premiums and other cost-sharing for beneficiaries, and im-
prove or expand guaranteed Medicare benefits and protect 
access to Medicare providers.
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SEC. 3602. NO CUTS IN GUARANTEED BENEFITS. 
Nothing in this Act shall result in the reduction or 
elimination of any benefits guaranteed by law to partici-
pants in Medicare Advantage plans. 
TITLE 
IV—PREVENTION 
OF 
CHRONIC DISEASE AND IM-
PROVING PUBLIC HEALTH 
Subtitle 
A—Modernizing 
Disease 
Prevention and Public Health 
Systems 
SEC. 4001. NATIONAL PREVENTION, HEALTH PROMOTION 
AND PUBLIC HEALTH COUNCIL. 
(a) ESTABLISHMENT.—The President shall establish, 
within the Department of Health and Human Services, a 
council to be known as the ‘‘National Prevention, Health 
Promotion and Public Health Council’’ (referred to in this 
section as the ‘‘Council’’). 
(b) CHAIRPERSON.—The President shall appoint the 
Surgeon General to serve as the chairperson of the Council. 
(c) COMPOSITION.—The Council shall be composed 
of— 
(1) the Secretary of Health and Human Serv-
ices; 
(2) the Secretary of Agriculture; 
(3) the Secretary of Education;
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(4) the Chairman of the Federal Trade Commis-
sion; 
(5) the Secretary of Transportation; 
(6) the Secretary of Labor; 
(7) the Secretary of Homeland Security; 
(8) the Administrator of the Environmental Pro-
tection Agency; 
(9) the Director of the Office of National Drug 
Control Policy; 
(10) the Director of the Domestic Policy Council; 
(11) the Assistant Secretary for Indian Affairs; 
(12) the Chairman of the Corporation for Na-
tional and Community Service; and 
(13) the head of any other Federal agency that 
the chairperson determines is appropriate. 
(d) PURPOSES AND DUTIES.—The Council shall— 
(1) provide coordination and leadership at the 
Federal level, and among all Federal departments and 
agencies, with respect to prevention, wellness and 
health promotion practices, the public health system, 
and integrative health care in the United States; 
(2) after obtaining input from relevant stake-
holders, develop a national prevention, health pro-
motion, public health, and integrative health care 
strategy that incorporates the most effective and
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achievable means of improving the health status of 
Americans and reducing the incidence of preventable 
illness and disability in the United States; 
(3) provide recommendations to the President 
and Congress concerning the most pressing health 
issues confronting the United States and changes in 
Federal policy to achieve national wellness, health 
promotion, and public health goals, including the re-
duction of tobacco use, sedentary behavior, and poor 
nutrition; 
(4) consider and propose evidence-based models, 
policies, and innovative approaches for the promotion 
of transformative models of prevention, integrative 
health, and public health on individual and commu-
nity levels across the United States; 
(5) establish processes for continual public input, 
including input from State, regional, and local lead-
ership communities and other relevant stakeholders, 
including Indian tribes and tribal organizations; 
(6) submit the reports required under subsection 
(g); and 
(7) carry out other activities determined appro-
priate by the President. 
(e) MEETINGS.—The Council shall meet at the call of 
the Chairperson.
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(f) ADVISORY GROUP.— 
(1) IN GENERAL.—The President shall establish 
an Advisory Group to the Council to be known as the 
‘‘Advisory Group on Prevention, Health Promotion, 
and Integrative and Public Health’’ (hereafter re-
ferred to in this section as the ‘‘Advisory Group’’). 
The Advisory Group shall be within the Department 
of Health and Human Services and report to the Sur-
geon General. 
(2) COMPOSITION.— 
(A) IN
GENERAL.—The Advisory Group 
shall be composed of not more than 25 non-Fed-
eral members to be appointed by the President. 
(B) 
REPRESENTATION.—In 
appointing 
members under subparagraph (A), the President 
shall ensure that the Advisory Group includes a 
diverse group of licensed health professionals, in-
cluding integrative health practitioners who have 
expertise in— 
(i) worksite health promotion; 
(ii) community services, including 
community health centers; 
(iii) preventive medicine; 
(iv) health coaching; 
(v) public health education;
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(vi) geriatrics; and 
(vii) rehabilitation medicine. 
(3) PURPOSES
AND
DUTIES.—The Advisory 
Group shall develop policy and program recommenda-
tions and advise the Council on lifestyle-based chronic 
disease prevention and management, integrative 
health care practices, and health promotion. 
(g) NATIONAL PREVENTION AND HEALTH PROMOTION 
STRATEGY.—Not later than 1 year after the date of enact-
ment of this Act, the Chairperson, in consultation with the 
Council, shall develop and make public a national preven-
tion, health promotion and public health strategy, and shall 
review and revise such strategy periodically. Such strategy 
shall— 
(1) set specific goals and objectives for improving 
the health of the United States through federally-sup-
ported prevention, health promotion, and public 
health programs, consistent with ongoing goal setting 
efforts conducted by specific agencies; 
(2) establish specific and measurable actions and 
timelines to carry out the strategy, and determine ac-
countability for meeting those timelines, within and 
across Federal departments and agencies; and 
(3) make recommendations to improve Federal 
efforts relating to prevention, health promotion, pub-
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lic health, and integrative health care practices to en-
sure Federal efforts are consistent with available 
standards and evidence. 
(h) REPORT.—Not later than July 1, 2010, and annu-
ally thereafter through January 1, 2015, the Council shall 
submit to the President and the relevant committees of Con-
gress, a report that— 
(1) describes the activities and efforts on preven-
tion, health promotion, and public health and activi-
ties to develop a national strategy conducted by the 
Council during the period for which the report is pre-
pared; 
(2) describes the national progress in meeting 
specific prevention, health promotion, and public 
health goals defined in the strategy and further de-
scribes corrective actions recommended by the Council 
and taken by relevant agencies and organizations to 
meet these goals; 
(3) contains a list of national priorities on 
health promotion and disease prevention to address 
lifestyle behavior modification (smoking cessation, 
proper nutrition, appropriate exercise, mental health, 
behavioral health, substance use disorder, and domes-
tic violence screenings) and the prevention measures 
for the 5 leading disease killers in the United States;
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(4) contains specific science-based initiatives to 
achieve the measurable goals of Healthy People 2010 
regarding nutrition, exercise, and smoking cessation, 
and targeting the 5 leading disease killers in the 
United States; 
(5) contains specific plans for consolidating Fed-
eral health programs and Centers that exist to pro-
mote healthy behavior and reduce disease risk (includ-
ing eliminating programs and offices determined to 
be ineffective in meeting the priority goals of Healthy 
People 2010); 
(6) contains specific plans to ensure that all 
Federal health care programs are fully coordinated 
with science-based prevention recommendations by the 
Director of the Centers for Disease Control and Pre-
vention; and 
(7) contains specific plans to ensure that all 
non-Department of Health and Human Services pre-
vention programs are based on the science-based 
guidelines developed by the Centers for Disease Con-
trol and Prevention under paragraph (4). 
(i) PERIODIC
REVIEWS.—The Secretary and the 
Comptroller General of the United States shall jointly con-
duct periodic reviews, not less than every 5 years, and eval-
uations of every Federal disease prevention and health pro-
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motion initiative, program, and agency. Such reviews shall 
be evaluated based on effectiveness in meeting metrics-based 
goals with an analysis posted on such agencies’ public 
Internet websites. 
SEC. 4002. PREVENTION AND PUBLIC HEALTH FUND. 
(a) PURPOSE.—It is the purpose of this section to es-
tablish a Prevention and Public Health Fund (referred to 
in this section as the ‘‘Fund’’), to be administered through 
the Department of Health and Human Services, Office of 
the Secretary, to provide for expanded and sustained na-
tional investment in prevention and public health programs 
to improve health and help restrain the rate of growth in 
private and public sector health care costs. 
(b) FUNDING.—There are hereby authorized to be ap-
propriated, and appropriated, to the Fund, out of any mon-
ies in the Treasury not otherwise appropriated— 
(1) for fiscal year 2010, $500,000,000; 
(2) for fiscal year 2011, $750,000,000; 
(3) for fiscal year 2012, $1,000,000,000; 
(4) for fiscal year 2013, $1,250,000,000; 
(5) for fiscal year 2014, $1,500,000,000; and 
(6) for fiscal year 2015, and each fiscal year 
thereafter, $2,000,000,000. 
(c) USE
OF FUND.—The Secretary shall transfer 
amounts in the Fund to accounts within the Department
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of Health and Human Services to increase funding, over 
the fiscal year 2008 level, for programs authorized by the 
Public Health Service Act, for prevention, wellness, and 
public health activities including prevention research and 
health screenings, such as the Community Transformation 
grant program, the Education and Outreach Campaign for 
Preventive Benefits, and immunization programs. 
(d) TRANSFER AUTHORITY.—The Committee on Ap-
propriations of the Senate and the Committee on Appro-
priations of the House of Representatives may provide for 
the transfer of funds in the Fund to eligible activities under 
this section, subject to subsection (c). 
SEC. 4003. CLINICAL AND COMMUNITY PREVENTIVE SERV-
ICES. 
(a) PREVENTIVE SERVICES TASK FORCE.—Section 
915 of the Public Health Service Act (42 U.S.C. 299b–4) 
is amended by striking subsection (a) and inserting the fol-
lowing: 
‘‘(a) PREVENTIVE SERVICES TASK FORCE.— 
‘‘(1) ESTABLISHMENT AND PURPOSE.—The Di-
rector shall convene an independent Preventive Serv-
ices Task Force (referred to in this subsection as the 
‘Task Force’) to be composed of individuals with ap-
propriate expertise. Such Task Force shall review the 
scientific evidence related to the effectiveness, appro-
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priateness, and cost-effectiveness of clinical preventive 
services for the purpose of developing recommenda-
tions for the health care community, and updating 
previous clinical preventive recommendations, to be 
published in the Guide to Clinical Preventive Services 
(referred to in this section as the ‘Guide’), for individ-
uals and organizations delivering clinical services, in-
cluding primary care professionals, health care sys-
tems, professional societies, employers, community or-
ganizations, non-profit organizations, Congress and 
other policy-makers, governmental public health agen-
cies, health care quality organizations, and organiza-
tions developing national health objectives. Such rec-
ommendations shall consider clinical preventive best 
practice recommendations from the Agency for 
Healthcare Research and Quality, the National Insti-
tutes of Health, the Centers for Disease Control and 
Prevention, the Institute of Medicine, specialty med-
ical associations, patient groups, and scientific soci-
eties. 
‘‘(2) DUTIES.—The duties of the Task Force shall 
include— 
‘‘(A) the development of additional topic 
areas for new recommendations and interven-
tions related to those topic areas, including those
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related to specific sub-populations and age 
groups; 
‘‘(B) at least once during every 5-year pe-
riod, review interventions and update rec-
ommendations related to existing topic areas, in-
cluding new or improved techniques to assess the 
health effects of interventions; 
‘‘(C) improved integration with Federal 
Government health objectives and related target 
setting for health improvement; 
‘‘(D) the enhanced dissemination of rec-
ommendations; 
‘‘(E) the provision of technical assistance to 
those health care professionals, agencies and or-
ganizations that request help in implementing 
the Guide recommendations; and 
‘‘(F) the submission of yearly reports to 
Congress and related agencies identifying gaps 
in research, such as preventive services that re-
ceive an insufficient evidence statement, and rec-
ommending priority areas that deserve further 
examination, including areas related to popu-
lations and age groups not adequately addressed 
by current recommendations.
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‘‘(3) ROLE OF AGENCY.—The Agency shall pro-
vide ongoing administrative, research, and technical 
support for the operations of the Task Force, includ-
ing coordinating and supporting the dissemination of 
the recommendations of the Task Force, ensuring ade-
quate staff resources, and assistance to those organiza-
tions requesting it for implementation of the Guide’s 
recommendations. 
‘‘(4) COORDINATION WITH COMMUNITY PREVEN-
TIVE SERVICES TASK FORCE.—The Task Force shall 
take appropriate steps to coordinate its work with the 
Community Preventive Services Task Force and the 
Advisory Committee on Immunization Practices, in-
cluding the examination of how each task force’s rec-
ommendations interact at the nexus of clinic and 
community. 
‘‘(5) OPERATION.—Operation. In carrying out 
the duties under paragraph (2), the Task Force is not 
subject to the provisions of Appendix 2 of title 5, 
United States Code. 
‘‘(6) INDEPENDENCE.—All members of the Task 
Force convened under this subsection, and any rec-
ommendations made by such members, shall be inde-
pendent and, to the extent practicable, not subject to 
political pressure.
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‘‘(7) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums as 
may be necessary for each fiscal year to carry out the 
activities of the Task Force.’’. 
(b) 
COMMUNITY
PREVENTIVE
SERVICES
TASK 
FORCE.— 
(1) IN GENERAL.—Part P of title III of the Pub-
lic Health Service Act, as amended by paragraph (2), 
is amended by adding at the end the following: 
‘‘SEC. 399U. COMMUNITY PREVENTIVE SERVICES TASK 
FORCE. 
‘‘(a) ESTABLISHMENT AND PURPOSE.—The Director of 
the Centers for Disease Control and Prevention shall con-
vene an independent Community Preventive Services Task 
Force (referred to in this subsection as the ‘Task Force’) 
to be composed of individuals with appropriate expertise. 
Such Task Force shall review the scientific evidence related 
to the effectiveness, appropriateness, and cost-effectiveness 
of community preventive interventions for the purpose of 
developing recommendations, to be published in the Guide 
to Community Preventive Services (referred to in this sec-
tion as the ‘Guide’), for individuals and organizations de-
livering population-based services, including primary care 
professionals, health care systems, professional societies, em-
ployers, community organizations, non-profit organiza-
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tions, schools, governmental public health agencies, Indian 
tribes, tribal organizations and urban Indian organiza-
tions, medical groups, Congress and other policy-makers. 
Community preventive services include any policies, pro-
grams, processes or activities designed to affect or otherwise 
affecting health at the population level. 
‘‘(b) DUTIES.—The duties of the Task Force shall in-
clude— 
‘‘(1) the development of additional topic areas 
for new recommendations and interventions related to 
those topic areas, including those related to specific 
populations and age groups, as well as the social, eco-
nomic and physical environments that can have 
broad effects on the health and disease of populations 
and health disparities among sub-populations and 
age groups; 
‘‘(2) at least once during every 5-year period, re-
view interventions and update recommendations re-
lated to existing topic areas, including new or im-
proved techniques to assess the health effects of inter-
ventions, including health impact assessment and 
population health modeling; 
‘‘(3) improved integration with Federal Govern-
ment health objectives and related target setting for 
health improvement;
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‘‘(4) the enhanced dissemination of recommenda-
tions; 
‘‘(5) the provision of technical assistance to those 
health care professionals, agencies, and organizations 
that request help in implementing the Guide rec-
ommendations; and 
‘‘(6) providing yearly reports to Congress and 
related agencies identifying gaps in research and rec-
ommending priority areas that deserve further exam-
ination, including areas related to populations and 
age groups not adequately addressed by current rec-
ommendations. 
‘‘(c) ROLE OF AGENCY.—The Director shall provide 
ongoing administrative, research, and technical support for 
the operations of the Task Force, including coordinating 
and supporting the dissemination of the recommendations 
of the Task Force, ensuring adequate staff resources, and 
assistance to those organizations requesting it for imple-
mentation of Guide recommendations. 
‘‘(d) COORDINATION WITH PREVENTIVE SERVICES 
TASK FORCE.—The Task Force shall take appropriate steps 
to coordinate its work with the U.S. Preventive Services 
Task Force and the Advisory Committee on Immunization 
Practices, including the examination of how each task
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force’s recommendations interact at the nexus of clinic and 
community. 
‘‘(e) OPERATION.—In carrying out the duties under 
subsection (b), the Task Force shall not be subject to the 
provisions of Appendix 2 of title 5, United States Code. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated such sums as may be nec-
essary for each fiscal year to carry out the activities of the 
Task Force.’’. 
(2) TECHNICAL AMENDMENTS.— 
(A) Section 399R of the Public Health Serv-
ice Act (as added by section 2 of the ALS Reg-
istry Act (Public Law 110–373; 122 Stat. 4047)) 
is redesignated as section 399S. 
(B) Section 399R of such Act (as added by 
section 3 of the Prenatally and Postnatally Di-
agnosed Conditions Awareness Act (Public Law 
110–374; 122 Stat. 4051)) is redesignated as sec-
tion 399T. 
SEC. 4004. EDUCATION AND OUTREACH CAMPAIGN RE-
GARDING PREVENTIVE BENEFITS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall provide for the planning and implementation 
of a national public–private partnership for a prevention
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and health promotion outreach and education campaign to 
raise public awareness of health improvement across the life 
span. Such campaign shall include the dissemination of in-
formation that— 
(1) describes the importance of utilizing preven-
tive services to promote wellness, reduce health dis-
parities, and mitigate chronic disease; 
(2) promotes the use of preventive services rec-
ommended by the United States Preventive Services 
Task Force and the Community Preventive Services 
Task Force; 
(3) encourages healthy behaviors linked to the 
prevention of chronic diseases; 
(4) explains the preventive services covered under 
health plans offered through a Gateway; 
(5) describes additional preventive care sup-
ported by the Centers for Disease Control and Preven-
tion, the Health Resources and Services Administra-
tion, the Substance Abuse and Mental Health Services 
Administration, the Advisory Committee on Immuni-
zation Practices, and other appropriate agencies; and 
(6) includes general health promotion informa-
tion. 
(b) CONSULTATION.—In coordinating the campaign 
under subsection (a), the Secretary shall consult with the
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Institute of Medicine to provide ongoing advice on evidence- 
based scientific information for policy, program develop-
ment, and evaluation. 
(c) MEDIA CAMPAIGN.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary, act-
ing through the Director of the Centers for Disease 
Control and Prevention, shall establish and imple-
ment a national science-based media campaign on 
health promotion and disease prevention. 
(2) REQUIREMENT
OF
CAMPAIGN.—The cam-
paign implemented under paragraph (1)— 
(A) shall be designed to address proper nu-
trition, regular exercise, smoking cessation, obe-
sity reduction, the 5 leading disease killers in the 
United States, and secondary prevention through 
disease screening promotion; 
(B) shall be carried out through competi-
tively bid contracts awarded to entities pro-
viding for the professional production and design 
of such campaign; 
(C) may include the use of television, radio, 
Internet, and other commercial marketing venues 
and may be targeted to specific age groups based 
on peer-reviewed social research;
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(D) shall not be duplicative of any other 
Federal efforts relating to health promotion and 
disease prevention; and 
(E) may include the use of humor and na-
tionally recognized positive role models. 
(3) EVALUATION.—The Secretary shall ensure 
that the campaign implemented under paragraph (1) 
is subject to an independent evaluation every 2 years 
and shall report every 2 years to Congress on the ef-
fectiveness of such campaigns towards meeting 
science-based metrics. 
(d) WEBSITE.—The Secretary, in consultation with 
private-sector experts, shall maintain or enter into a con-
tract to maintain an Internet website to provide science- 
based information on guidelines for nutrition, regular exer-
cise, obesity reduction, smoking cessation, and specific 
chronic disease prevention. Such website shall be designed 
to provide information to health care providers and con-
sumers. 
(e) DISSEMINATION OF INFORMATION THROUGH PRO-
VIDERS.—The Secretary, acting through the Centers for 
Disease Control and Prevention, shall develop and imple-
ment a plan for the dissemination of health promotion and 
disease prevention information consistent with national 
priorities, to health care providers who participate in Fed-
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eral programs, including programs administered by the In-
dian Health Service, the Department of Veterans Affairs, 
the Department of Defense, and the Health Resources and 
Services Administration, and Medicare and Medicaid. 
(f) PERSONALIZED PREVENTION PLANS.— 
(1) CONTRACT.—The Secretary, acting through 
the Director of the Centers for Disease Control and 
Prevention, shall enter into a contract with a quali-
fied entity for the development and operation of a 
Federal Internet website personalized prevention plan 
tool. 
(2) USE.—The website developed under para-
graph (1) shall be designed to be used as a source of 
the most up-to-date scientific evidence relating to dis-
ease prevention for use by individuals. Such website 
shall contain a component that enables an individual 
to determine their disease risk (based on personal 
health and family history, BMI, and other relevant 
information) relating to the 5 leading diseases in the 
United States, and obtain personalized suggestions for 
preventing such diseases. 
(g) INTERNET PORTAL.—The Secretary shall establish 
an Internet portal for accessing risk-assessment tools devel-
oped and maintained by private and academic entities.
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(h) PRIORITY FUNDING.—Funding for the activities 
authorized under this section shall take priority over fund-
ing provided through the Centers for Disease Control and 
Prevention for grants to States and other entities for simi-
lar purposes and goals as provided for in this section. Not 
to exceed $500,000,000 shall be expended on the campaigns 
and activities required under this section. 
(i) PUBLIC AWARENESS OF PREVENTIVE AND OBE-
SITY-RELATED SERVICES.— 
(1) INFORMATION TO STATES.—The Secretary of 
Health and Human Services shall provide guidance 
and relevant information to States and health care 
providers regarding preventive and obesity-related 
services that are available to Medicaid enrollees, in-
cluding obesity screening and counseling for children 
and adults. 
(2) INFORMATION TO ENROLLEES.—Each State 
shall design a public awareness campaign to educate 
Medicaid enrollees regarding availability and cov-
erage of such services, with the goal of reducing 
incidences of obesity. 
(3) REPORT.—Not later than January 1, 2011, 
and every 3 years thereafter through January 1, 
2017, the Secretary of Health and Human Services 
shall report to Congress on the status and effectiveness
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of efforts under paragraphs (1) and (2), including 
summaries of the States’ efforts to increase awareness 
of coverage of obesity-related services. 
(j) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated such sums as may be nec-
essary to carry out this section. 
Subtitle B—Increasing Access to 
Clinical Preventive Services 
SEC. 4101. SCHOOL-BASED HEALTH CENTERS. 
(a) GRANTS FOR THE ESTABLISHMENT OF SCHOOL- 
BASED HEALTH CENTERS.— 
(1) PROGRAM.—The Secretary of Health and 
Human Services (in this subsection referred to as the 
‘‘Secretary’’) shall establish a program to award 
grants to eligible entities to support the operation of 
school-based health centers. 
(2) ELIGIBILITY.—To be eligible for a grant 
under this subsection, an entity shall— 
(A) be a school-based health center or a 
sponsoring facility of a school-based health cen-
ter; and 
(B) submit an application at such time, in 
such manner, and containing such information 
as the Secretary may require, including at a 
minimum an assurance that funds awarded
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under the grant shall not be used to provide any 
service that is not authorized or allowed by Fed-
eral, State, or local law. 
(3) PREFERENCE.—In awarding grants under 
this section, the Secretary shall give preference to 
awarding grants for school-based health centers that 
serve a large population of children eligible for med-
ical assistance under the State Medicaid plan under 
title XIX of the Social Security Act or under a waiver 
of such plan or children eligible for child health as-
sistance under the State child health plan under title 
XXI of that Act (42 U.S.C. 1397aa et seq.). 
(4) LIMITATION ON USE OF FUNDS.—An eligible 
entity shall use funds provided under a grant award-
ed under this subsection only for expenditures for fa-
cilities (including the acquisition or improvement of 
land, or the acquisition, construction, expansion, re-
placement, or other improvement of any building or 
other facility), equipment, or similar expenditures, as 
specified by the Secretary. No funds provided under 
a grant awarded under this section shall be used for 
expenditures for personnel or to provide health serv-
ices. 
(5) APPROPRIATIONS.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
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priated for each of fiscal years 2010 through 2013, 
$50,000,000 for the purpose of carrying out this sub-
section. Funds appropriated under this paragraph 
shall remain available until expended. 
(6) DEFINITIONS.—In this subsection, the terms 
‘‘school-based health center’’ and ‘‘sponsoring facility’’ 
have the meanings given those terms in section 
2110(c)(9) of the Social Security Act (42 U.S.C. 
1397jj(c)(9)). 
(b) GRANTS FOR THE OPERATION OF SCHOOL-BASED 
HEALTH CENTERS.—Part Q of title III of the Public 
Health Service Act (42 U.S.C. 280h et seq.) is amended by 
adding at the end the following: 
‘‘SEC. 399Z–1. SCHOOL-BASED HEALTH CENTERS. 
‘‘(a) DEFINITIONS; ESTABLISHMENT OF CRITERIA.— 
In this section: 
‘‘(1) COMPREHENSIVE PRIMARY HEALTH SERV-
ICES.—The term ‘comprehensive primary health serv-
ices’ means the core services offered by school-based 
health centers, which shall include the following: 
‘‘(A) PHYSICAL.—Comprehensive health as-
sessments, diagnosis, and treatment of minor, 
acute, and chronic medical conditions, and refer-
rals to, and follow-up for, specialty care and oral 
health services.
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‘‘(B) MENTAL HEALTH.—Mental health and 
substance use disorder assessments, crisis inter-
vention, counseling, treatment, and referral to a 
continuum of services including emergency psy-
chiatric care, community support programs, in-
patient care, and outpatient programs. 
‘‘(2) MEDICALLY UNDERSERVED CHILDREN AND 
ADOLESCENTS.— 
‘‘(A) IN
GENERAL.—The term ‘medically 
underserved children and adolescents’ means a 
population of children and adolescents who are 
residents of an area designated as a medically 
underserved area or a health professional short-
age area by the Secretary. 
‘‘(B) CRITERIA.—The Secretary shall pre-
scribe criteria for determining the specific short-
ages of personal health services for medically un-
derserved children and adolescents under sub-
paragraph (A) that shall— 
‘‘(i) take into account any comments 
received by the Secretary from the chief ex-
ecutive officer of a State and local officials 
in a State; and 
‘‘(ii) include factors indicative of the 
health status of such children and adoles-
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cents of an area, including the ability of the 
residents of such area to pay for health serv-
ices, the accessibility of such services, the 
availability of health professionals to such 
children and adolescents, and other factors 
as determined appropriate by the Secretary. 
‘‘(3) SCHOOL-BASED
HEALTH
CENTER.—The 
term ‘school-based health center’ means a health clinic 
that— 
‘‘(A) meets the definition of a school-based 
health center under section 2110(c)(9)(A) of the 
Social Security Act and is administered by a 
sponsoring facility (as defined in section 
2110(c)(9)(B) of the Social Security Act); 
‘‘(B) provides, at a minimum, comprehen-
sive primary health services during school hours 
to children and adolescents by health profes-
sionals in accordance with established standards, 
community practice, reporting laws, and other 
State laws, including parental consent and noti-
fication laws that are not inconsistent with Fed-
eral law; and 
‘‘(C) does not perform abortion services. 
‘‘(b) AUTHORITY TO AWARD GRANTS.—The Secretary 
shall award grants for the costs of the operation of school-
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based health centers (referred to in this section as ‘SBHCs’) 
that meet the requirements of this section. 
‘‘(c) APPLICATIONS.—To be eligible to receive a grant 
under this section, an entity shall— 
‘‘(1) be an SBHC (as defined in subsection 
(a)(3)); and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing— 
‘‘(A) evidence that the applicant meets all 
criteria necessary to be designated an SBHC; 
‘‘(B) evidence of local need for the services 
to be provided by the SBHC; 
‘‘(C) an assurance that— 
‘‘(i) SBHC services will be provided to 
those children and adolescents for whom pa-
rental or guardian consent has been ob-
tained in cooperation with Federal, State, 
and local laws governing health care service 
provision to children and adolescents; 
‘‘(ii) the SBHC has made and will 
continue to make every reasonable effort to 
establish and maintain collaborative rela-
tionships with other health care providers 
in the catchment area of the SBHC;
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‘‘(iii) the SBHC will provide on-site 
access during the academic day when school 
is in session and 24-hour coverage through 
an on-call system and through its backup 
health providers to ensure access to services 
on a year-round basis when the school or 
the SBHC is closed; 
‘‘(iv) the SBHC will be integrated into 
the school environment and will coordinate 
health services with school personnel, such 
as administrators, teachers, nurses, coun-
selors, and support personnel, as well as 
with other community providers co-located 
at the school; 
‘‘(v) the SBHC sponsoring facility as-
sumes all responsibility for the SBHC ad-
ministration, operations, and oversight; and 
‘‘(vi) the SBHC will comply with Fed-
eral, State, and local laws concerning pa-
tient privacy and student records, including 
regulations promulgated under the Health 
Insurance Portability and Accountability 
Act of 1996 and section 444 of the General 
Education Provisions Act; and
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‘‘(D) such other information as the Sec-
retary may require. 
‘‘(d) PREFERENCES AND CONSIDERATION.—In review-
ing applications: 
‘‘(1) The Secretary may give preference to appli-
cants who demonstrate an ability to serve the fol-
lowing: 
‘‘(A) Communities that have evidenced bar-
riers to primary health care and mental health 
and substance use disorder prevention services 
for children and adolescents. 
‘‘(B) Communities with high per capita 
numbers of children and adolescents who are un-
insured, underinsured, or enrolled in public 
health insurance programs. 
‘‘(C) Populations of children and adoles-
cents that have historically demonstrated dif-
ficulty in accessing health and mental health 
and substance use disorder prevention services. 
‘‘(2) The Secretary may give consideration to 
whether an applicant has received a grant under sub-
section (a) of section 4101 of the Patient Protection 
and Affordable Care Act. 
‘‘(e) WAIVER
OF
REQUIREMENTS.—The Secretary 
may—
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‘‘(1) under appropriate circumstances, waive the 
application of all or part of the requirements of this 
subsection with respect to an SBHC for not to exceed 
2 years; and 
‘‘(2) upon a showing of good cause, waive the re-
quirement that the SBHC provide all required com-
prehensive primary health services for a designated 
period of time to be determined by the Secretary. 
‘‘(f) USE OF FUNDS.— 
‘‘(1) FUNDS.—Funds awarded under a grant 
under this section— 
‘‘(A) may be used for— 
‘‘(i) acquiring and leasing equipment 
(including the costs of amortizing the prin-
ciple of, and paying interest on, loans for 
such equipment); 
‘‘(ii) providing training related to the 
provision of required comprehensive pri-
mary health services and additional health 
services; 
‘‘(iii) the management and operation 
of health center programs; 
‘‘(iv) the payment of salaries for physi-
cians, nurses, and other personnel of the 
SBHC; and
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‘‘(B) may not be used to provide abortions. 
‘‘(2) CONSTRUCTION.—The Secretary may award 
grants which may be used to pay the costs associated 
with expanding and modernizing existing buildings 
for use as an SBHC, including the purchase of trail-
ers or manufactured buildings to install on the school 
property. 
‘‘(3) LIMITATIONS.— 
‘‘(A) IN GENERAL.—Any provider of serv-
ices that is determined by a State to be in viola-
tion of a State law described in subsection 
(a)(3)(B) with respect to activities carried out at 
a SBHC shall not be eligible to receive addi-
tional funding under this section. 
‘‘(B) NO OVERLAPPING GRANT PERIOD.—No 
entity that has received funding under section 
330 for a grant period shall be eligible for a 
grant under this section for with respect to the 
same grant period. 
‘‘(g) MATCHING REQUIREMENT.— 
‘‘(1) IN GENERAL.—Each eligible entity that re-
ceives a grant under this section shall provide, from 
non-Federal sources, an amount equal to 20 percent 
of the amount of the grant (which may be provided
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in cash or in-kind) to carry out the activities sup-
ported by the grant. 
‘‘(2) WAIVER.—The Secretary may waive all or 
part of the matching requirement described in para-
graph (1) for any fiscal year for the SBHC if the Sec-
retary determines that applying the matching re-
quirement to the SBHC would result in serious hard-
ship or an inability to carry out the purposes of this 
section. 
‘‘(h) SUPPLEMENT, NOT SUPPLANT.—Grant funds 
provided under this section shall be used to supplement, not 
supplant, other Federal or State funds. 
‘‘(i) EVALUATION.—The Secretary shall develop and 
implement a plan for evaluating SBHCs and monitoring 
quality performance under the awards made under this sec-
tion. 
‘‘(j) AGE APPROPRIATE SERVICES.—An eligible entity 
receiving funds under this section shall only provide age 
appropriate services through a SBHC funded under this 
section to an individual. 
‘‘(k) PARENTAL CONSENT.—An eligible entity receiv-
ing funds under this section shall not provide services 
through a SBHC funded under this section to an individual 
without the consent of the parent or guardian of such indi-
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vidual if such individual is considered a minor under ap-
plicable State law. 
‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—For pur-
poses of carrying out this section, there are authorized to 
be appropriated such sums as may be necessary for each 
of the fiscal years 2010 through 2014.’’. 
SEC. 4102. ORAL HEALTHCARE PREVENTION ACTIVITIES. 
(a) IN GENERAL.—Title III of the Public Health Serv-
ice Act (42 U.S.C. 241 et seq.), as amended by section 3025, 
is amended by adding at the end the following: 
‘‘PART T—ORAL HEALTHCARE PREVENTION 
ACTIVITIES 
‘‘SEC. 399LL. ORAL HEALTHCARE PREVENTION EDUCATION 
CAMPAIGN. 
‘‘(a) ESTABLISHMENT.—The Secretary, acting through 
the Director of the Centers for Disease Control and Preven-
tion and in consultation with professional oral health orga-
nizations, shall, subject to the availability of appropria-
tions, establish a 5-year national, public education cam-
paign (referred to in this section as the ‘campaign’) that 
is focused on oral healthcare prevention and education, in-
cluding prevention of oral disease such as early childhood 
and other caries, periodontal disease, and oral cancer. 
‘‘(b) REQUIREMENTS.—In establishing the campaign, 
the Secretary shall—
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‘‘(1) ensure that activities are targeted towards 
specific populations such as children, pregnant 
women, parents, the elderly, individuals with disabil-
ities, and ethnic and racial minority populations, in-
cluding Indians, Alaska Natives and Native Hawai-
ians (as defined in section 4(c) of the Indian Health 
Care Improvement Act) in a culturally and linguis-
tically appropriate manner; and 
‘‘(2) utilize science-based strategies to convey 
oral health prevention messages that include, but are 
not limited to, community water fluoridation and 
dental sealants. 
‘‘(c) PLANNING
AND IMPLEMENTATION.—Not later 
than 2 years after the date of enactment of this section, the 
Secretary shall begin implementing the 5-year campaign. 
During the 2-year period referred to in the previous sen-
tence, the Secretary shall conduct planning activities with 
respect to the campaign. 
‘‘SEC. 399LL–1. RESEARCH-BASED DENTAL CARIES DISEASE 
MANAGEMENT. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, 
shall award demonstration grants to eligible entities to 
demonstrate the effectiveness of research-based dental caries 
disease management activities.
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‘‘(b) ELIGIBILITY.—To be eligible for a grant under 
this section, an entity shall— 
‘‘(1) be a community-based provider of dental 
services (as defined by the Secretary), including a 
Federally-qualified health center, a clinic of a hos-
pital owned or operated by a State (or by an instru-
mentality or a unit of government within a State), a 
State or local department of health, a dental program 
of the Indian Health Service, an Indian tribe or trib-
al organization, or an urban Indian organization (as 
such terms are defined in section 4 of the Indian 
Health Care Improvement Act), a health system pro-
vider, a private provider of dental services, medical, 
dental, public health, nursing, nutrition educational 
institutions, or national organizations involved in 
improving children’s oral health; and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—A grantee shall use amounts re-
ceived under a grant under this section to demonstrate the 
effectiveness of research-based dental caries disease manage-
ment activities. 
‘‘(d) USE OF INFORMATION.—The Secretary shall uti-
lize information generated from grantees under this section
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in planning and implementing the public education cam-
paign under section 399LL. 
‘‘SEC. 399LL–2. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated to carry out 
this part, such sums as may be necessary.’’. 
(b) SCHOOL-BASED
SEALANT
PROGRAMS.—Section 
317M(c)(1) of the Public Health Service Act (42 U.S.C. 
247b–14(c)(1)) is amended by striking ‘‘may award grants 
to States and Indian tribes’’ and inserting ‘‘shall award 
a grant to each of the 50 States and territories and to Indi-
ans, Indian tribes, tribal organizations and urban Indian 
organizations (as such terms are defined in section 4 of the 
Indian Health Care Improvement Act)’’. 
(c) ORAL HEALTH INFRASTRUCTURE.—Section 317M 
of the Public Health Service Act (42 U.S.C. 247b–14) is 
amended— 
(1) by redesignating subsections (d) and (e) as 
subsections (e) and (f), respectively; and 
(2) by inserting after subsection (c), the fol-
lowing: 
‘‘(d) ORAL HEALTH INFRASTRUCTURE.— 
‘‘(1) COOPERATIVE
AGREEMENTS.—The Sec-
retary, acting through the Director of the Centers for 
Disease Control and Prevention, shall enter into coop-
erative agreements with State, territorial, and Indian
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tribes or tribal organizations (as those terms are de-
fined in section 4 of the Indian Health Care Improve-
ment Act) to establish oral health leadership and pro-
gram guidance, oral health data collection and inter-
pretation, (including determinants of poor oral health 
among vulnerable populations), a multi-dimensional 
delivery system for oral health, and to implement 
science-based programs (including dental sealants and 
community water fluoridation) to improve oral 
health. 
‘‘(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated such sums as 
necessary to carry out this subsection for fiscal years 
2010 through 2014.’’. 
(d) UPDATING NATIONAL ORAL HEALTHCARE SUR-
VEILLANCE ACTIVITIES.— 
(1) PRAMS.— 
(A) IN GENERAL.—The Secretary of Health 
and Human Services (referred to in this sub-
section as the ‘‘Secretary’’) shall carry out ac-
tivities to update and improve the Pregnancy 
Risk Assessment Monitoring System (referred to 
in this section as ‘‘PRAMS’’) as it relates to oral 
healthcare.
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(B) STATE
REPORTS
AND
MANDATORY 
MEASUREMENTS.— 
(i) IN
GENERAL.—Not later than 5 
years after the date of enactment of this Act, 
and every 5 years thereafter, a State shall 
submit to the Secretary a report concerning 
activities conducted within the State under 
PRAMS. 
(ii) 
MEASUREMENTS.—The 
oral 
healthcare measurements developed by the 
Secretary for use under PRAMS shall be 
mandatory with respect to States for pur-
poses of the State reports under clause (i). 
(C) FUNDING.—There is authorized to be 
appropriated to carry out this paragraph, such 
sums as may be necessary. 
(2) NATIONAL HEALTH AND NUTRITION EXAMINA-
TION
SURVEY.—The Secretary shall develop oral 
healthcare components that shall include tooth-level 
surveillance for inclusion in the National Health and 
Nutrition Examination Survey. Such components 
shall be updated by the Secretary at least every 6 
years. For purposes of this paragraph, the term 
‘‘tooth-level surveillance’’ means a clinical examina-
tion where an examiner looks at each dental surface,
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on each tooth in the mouth and as expanded by the 
Division of Oral Health of the Centers for Disease 
Control and Prevention. 
(3) MEDICAL EXPENDITURES PANEL SURVEY.— 
The Secretary shall ensure that the Medical Expendi-
tures Panel Survey by the Agency for Healthcare Re-
search and Quality includes the verification of dental 
utilization, 
expenditure, 
and 
coverage 
findings 
through conduct of a look-back analysis. 
(4) NATIONAL ORAL HEALTH SURVEILLANCE SYS-
TEM.— 
(A) APPROPRIATIONS.—There is authorized 
to be appropriated, such sums as may be nec-
essary for each of fiscal years 2010 through 2014 
to increase the participation of States in the Na-
tional Oral Health Surveillance System from 16 
States to all 50 States, territories, and District 
of Columbia. 
(B) REQUIREMENTS.—The Secretary shall 
ensure that the National Oral Health Surveil-
lance System include the measurement of early 
childhood caries.
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SEC. 4103. MEDICARE COVERAGE OF ANNUAL WELLNESS 
VISIT PROVIDING A PERSONALIZED PREVEN-
TION PLAN. 
(a) COVERAGE OF PERSONALIZED PREVENTION PLAN 
SERVICES.— 
(1) IN GENERAL.—Section 1861(s)(2) of the So-
cial Security Act (42 U.S.C. 1395x(s)(2)) is amend-
ed— 
(A) in subparagraph (DD), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (EE), by adding 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(FF) personalized prevention plan services (as 
defined in subsection (hhh));’’. 
(2) CONFORMING AMENDMENTS.—Clauses (i) and 
(ii) of section 1861(s)(2)(K) of the Social Security 
Act (42 U.S.C. 1395x(s)(2)(K)) are each amended by 
striking ‘‘subsection (ww)(1)’’ and inserting ‘‘sub-
sections (ww)(1) and (hhh)’’. 
(b) PERSONALIZED PREVENTION PLAN SERVICES DE-
FINED.—Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended by adding at the end the following new 
subsection:
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‘‘Annual Wellness Visit 
‘‘(hhh)(1) The term ‘personalized prevention plan serv-
ices’ means the creation of a plan for an individual— 
‘‘(A) that includes a health risk assessment (that 
meets the guidelines established by the Secretary 
under paragraph (4)(A)) of the individual that is 
completed prior to or as part of the same visit with 
a health professional described in paragraph (3); and 
‘‘(B) that— 
‘‘(i) takes into account the results of the 
health risk assessment; and 
‘‘(ii) may contain the elements described in 
paragraph (2). 
‘‘(2) Subject to paragraph (4)(H), the elements de-
scribed in this paragraph are the following: 
‘‘(A) The establishment of, or an update to, the 
individual’s medical and family history. 
‘‘(B) A list of current providers and suppliers 
that are regularly involved in providing medical care 
to the individual (including a list of all prescribed 
medications). 
‘‘(C) A measurement of height, weight, body 
mass index (or waist circumference, if appropriate), 
blood pressure, and other routine measurements. 
‘‘(D) Detection of any cognitive impairment.
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‘‘(E) The establishment of, or an update to, the 
following: 
‘‘(i) A screening schedule for the next 5 to 
10 years, as appropriate, based on recommenda-
tions of the United States Preventive Services 
Task Force and the Advisory Committee on Im-
munization Practices, and the individual’s 
health status, screening history, and age-appro-
priate preventive services covered under this title. 
‘‘(ii) A list of risk factors and conditions for 
which primary, secondary, or tertiary preven-
tion interventions are recommended or are un-
derway, including any mental health conditions 
or any such risk factors or conditions that have 
been identified through an initial preventive 
physical examination (as described under sub-
section (ww)(1)), and a list of treatment options 
and their associated risks and benefits. 
‘‘(F) The furnishing of personalized health advice 
and a referral, as appropriate, to health education or 
preventive counseling services or programs aimed at 
reducing identified risk factors and improving self- 
management, or community-based lifestyle interven-
tions to reduce health risks and promote self-manage-
ment and wellness, including weight loss, physical ac-
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tivity, smoking cessation, fall prevention, and nutri-
tion. 
‘‘(G) Any other element determined appropriate 
by the Secretary. 
‘‘(3) A health professional described in this paragraph 
is— 
‘‘(A) a physician; 
‘‘(B) a practitioner described in clause (i) of sec-
tion 1842(b)(18)(C); or 
‘‘(C) a medical professional (including a health 
educator, registered dietitian, or nutrition profes-
sional) or a team of medical professionals, as deter-
mined appropriate by the Secretary, under the super-
vision of a physician. 
‘‘(4)(A) For purposes of paragraph (1)(A), the Sec-
retary, not later than 1 year after the date of enactment 
of this subsection, shall establish publicly available guide-
lines for health risk assessments. Such guidelines shall be 
developed in consultation with relevant groups and entities 
and shall provide that a health risk assessment— 
‘‘(i) identify chronic diseases, injury risks, modi-
fiable risk factors, and urgent health needs of the in-
dividual; and 
‘‘(ii) may be furnished—
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(A) and may be used to meet the requirement under para-
graph (1)(A). 
‘‘(ii) Any health risk assessment that meets the guide-
lines under subparagraph (A) and is approved by the Sec-
retary may be used to meet the requirement under para-
graph (1)(A). 
‘‘(D) The Secretary may coordinate with community- 
based entities (including State Health Insurance Programs, 
Area Agencies on Aging, Aging and Disability Resource 
Centers, and the Administration on Aging) to— 
‘‘(i) ensure that health risk assessments are ac-
cessible to beneficiaries; and 
‘‘(ii) provide appropriate support for the comple-
tion of health risk assessments by beneficiaries. 
‘‘(E) The Secretary shall establish procedures to make 
beneficiaries and providers aware of the requirement that 
a beneficiary complete a health risk assessment prior to or 
at the same time as receiving personalized prevention plan 
services. 
‘‘(F) To the extent practicable, the Secretary shall en-
courage the use of, integration with, and coordination of 
health information technology (including use of technology 
that is compatible with electronic medical records and per-
sonal health records) and may experiment with the use of 
personalized technology to aid in the development of self-
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management skills and management of and adherence to 
provider recommendations in order to improve the health 
status of beneficiaries. 
‘‘(G)(i) A beneficiary shall only be eligible to receive 
an initial preventive physical examination (as defined 
under subsection (ww)(1)) at any time during the 12-month 
period after the date that the beneficiary’s coverage begins 
under part B and shall be eligible to receive personalized 
prevention plan services under this subsection provided that 
the beneficiary has not received such services within the pre-
ceding 12-month period. 
‘‘(ii) The Secretary shall establish procedures to make 
beneficiaries aware of the option to select an initial preven-
tive physical examination or personalized prevention plan 
services during the period of 12 months after the date that 
a beneficiary’s coverage begins under part B, which shall 
include information regarding any relevant differences be-
tween such services. 
‘‘(H) The Secretary shall issue guidance that— 
‘‘(i) identifies elements under paragraph (2) that 
are required to be provided to a beneficiary as part 
of their first visit for personalized prevention plan 
services; and 
‘‘(ii) establishes a yearly schedule for appro-
priate provision of such elements thereafter.’’.
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(c) PAYMENT AND ELIMINATION OF COST-SHARING.— 
(1) PAYMENT
AND
ELIMINATION
OF
COINSUR-
ANCE.—Section 1833(a)(1) of the Social Security Act 
(42 U.S.C. 1395l(a)(1)) is amended— 
(A) in subparagraph (N), by inserting 
‘‘other than personalized prevention plan services 
(as defined in section 1861(hhh)(1))’’ after ‘‘(as 
defined in section 1848(j)(3))’’; 
(B) by striking ‘‘and’’ before ‘‘(W)’’; and 
(C) by inserting before the semicolon at the 
end the following: ‘‘, and (X) with respect to per-
sonalized prevention plan services (as defined in 
section 1861(hhh)(1)), the amount paid shall be 
100 percent of the lesser of the actual charge for 
the services or the amount determined under the 
payment basis determined under section 1848’’. 
(2) PAYMENT
UNDER
PHYSICIAN
FEE
SCHED-
ULE.—Section 1848(j)(3) of the Social Security Act 
(42 U.S.C. 1395w–4(j)(3)) is amended by inserting 
‘‘(2)(FF) (including administration of the health risk 
assessment) ,’’ after ‘‘(2)(EE),’’. 
(3) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.— 
(A) EXCLUSION
FROM
OPD
FEE
SCHED-
ULE.—Section 1833(t)(1)(B)(iv) of the Social
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Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is 
amended by striking ‘‘and diagnostic mammog-
raphy’’ and inserting ‘‘, diagnostic mammog-
raphy, or personalized prevention plan services 
(as defined in section 1861(hhh)(1))’’. 
(B) CONFORMING
AMENDMENTS.—Section 
1833(a)(2) of the Social Security Act (42 U.S.C. 
1395l(a)(2)) is amended— 
(i) in subparagraph (F), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (G)(ii), by strik-
ing the comma at the end and inserting ‘‘; 
and’’; and 
(iii) by inserting after subparagraph 
(G)(ii) the following new subparagraph: 
‘‘(H) with respect to personalized preven-
tion plan services (as defined in section 
1861(hhh)(1)) furnished by an outpatient de-
partment of a hospital, the amount determined 
under paragraph (1)(X),’’. 
(4) WAIVER OF APPLICATION OF DEDUCTIBLE.— 
The first sentence of section 1833(b) of the Social Se-
curity Act (42 U.S.C. 1395l(b)) is amended— 
(A) by striking ‘‘and’’ before ‘‘(9)’’; and
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(B) by inserting before the period the fol-
lowing: ‘‘, and (10) such deductible shall not 
apply with respect to personalized prevention 
plan 
services 
(as 
defined 
in 
section 
1861(hhh)(1))’’. 
(d) FREQUENCY LIMITATION.—Section 1862(a) of the 
Social Security Act (42 U.S.C. 1395y(a)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (N), by striking ‘‘and’’ 
at the end; 
(B) in subparagraph (O), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(P) in the case of personalized prevention plan 
services (as defined in section 1861(hhh)(1)), which 
are performed more frequently than is covered under 
such section;’’; and 
(2) in paragraph (7), by striking ‘‘or (K)’’ and 
inserting ‘‘(K), or (P)’’. 
(e) EFFECTIVE DATE.—The amendments made by this 
section shall apply to services furnished on or after January 
1, 2011.
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SEC. 4104. REMOVAL OF BARRIERS TO PREVENTIVE SERV-
ICES IN MEDICARE. 
(a) DEFINITION OF PREVENTIVE SERVICES.—Section 
1861(ddd) of the Social Security Act (42 U.S.C. 
1395x(ddd)) is amended— 
(1) in the heading, by inserting ‘‘; Preventive 
Services’’ after ‘‘Services’’; 
(2) in paragraph (1), by striking ‘‘not otherwise 
described in this title’’ and inserting ‘‘not described 
in subparagraph (A) or (C) of paragraph (3)’’; and 
(3) by adding at the end the following new para-
graph: 
‘‘(3) The term ‘preventive services’ means the fol-
lowing: 
‘‘(A) The screening and preventive services de-
scribed in subsection (ww)(2) (other than the service 
described in subparagraph (M) of such subsection). 
‘‘(B) An initial preventive physical examination 
(as defined in subsection (ww)). 
‘‘(C) Personalized prevention plan services (as 
defined in subsection (hhh)(1)).’’. 
(b) COINSURANCE.— 
(1) GENERAL APPLICATION.— 
(A) IN GENERAL.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)), as 
amended by section 4103(c)(1), is amended—
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(i) in subparagraph (T), by inserting 
‘‘(or 100 percent if such services are rec-
ommended with a grade of A or B by the 
United States Preventive Services Task 
Force for any indication or population and 
are appropriate for the individual)’’ after 
‘‘80 percent’’; 
(ii) in subparagraph (W)— 
(I) in clause (i), by inserting ‘‘(if 
such subparagraph were applied, by 
substituting ‘100 percent’ for ‘80 per-
cent’)’’ after ‘‘subparagraph (D)’’; and 
(II) in clause (ii), by striking ‘‘80 
percent’’ and inserting ‘‘100 percent’’; 
(iii) by striking ‘‘and’’ before ‘‘(X)’’; 
and 
(iv) by inserting before the semicolon 
at the end the following: ‘‘, and (Y) with re-
spect to preventive services described in sub-
paragraphs 
(A) 
and 
(B) 
of 
section 
1861(ddd)(3) that are appropriate for the 
individual and, in the case of such services 
described in subparagraph (A), are rec-
ommended with a grade of A or B by the 
United States Preventive Services Task
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Force for any indication or population, the 
amount paid shall be 100 percent of the 
lesser of the actual charge for the services or 
the amount determined under the fee sched-
ule that applies to such services under this 
part’’. 
(2) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.— 
(A) EXCLUSION
FROM
OPD
FEE
SCHED-
ULE.—Section 1833(t)(1)(B)(iv) of the Social 
Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)), as 
amended by section 4103(c)(3)(A), is amended— 
(i) by striking ‘‘or’’ before ‘‘personal-
ized prevention plan services’’; and 
(ii) by inserting before the period the 
following: ‘‘, or preventive services described 
in subparagraphs (A) and (B) of section 
1861(ddd)(3) that are appropriate for the 
individual and, in the case of such services 
described in subparagraph (A), are rec-
ommended with a grade of A or B by the 
United States Preventive Services Task 
Force for any indication or population’’. 
(B) CONFORMING
AMENDMENTS.—Section 
1833(a)(2) of the Social Security Act (42 U.S.C.
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1395l(a)(2)), 
as 
amended 
by 
section 
4103(c)(3)(B), is amended— 
(i) in subparagraph (G)(ii), by strik-
ing ‘‘and’’ after the semicolon at the end; 
(ii) in subparagraph (H), by striking 
the comma at the end and inserting ‘‘; 
and’’; and 
(iii) by inserting after subparagraph 
(H) the following new subparagraph: 
‘‘(I) with respect to preventive services de-
scribed in subparagraphs (A) and (B) of section 
1861(ddd)(3) that are appropriate for the indi-
vidual and are furnished by an outpatient de-
partment of a hospital and, in the case of such 
services described in subparagraph (A), are rec-
ommended with a grade of A or B by the United 
States Preventive Services Task Force for any 
indication or population, the amount determined 
under paragraph (1)(W) or (1)(Y),’’. 
(c) WAIVER OF APPLICATION OF DEDUCTIBLE FOR 
PREVENTIVE
SERVICES
AND
COLORECTAL
CANCER 
SCREENING TESTS.—Section 1833(b) of the Social Security 
Act (42 U.S.C. 1395l(b)), as amended by section 4103(c)(4), 
is amended—
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(1) in paragraph (1), by striking ‘‘items and 
services described in section 1861(s)(10)(A)’’ and in-
serting ‘‘preventive services described in subparagraph 
(A) of section 1861(ddd)(3) that are recommended 
with a grade of A or B by the United States Preven-
tive Services Task Force for any indication or popu-
lation and are appropriate for the individual.’’; and 
(2) by adding at the end the following new sen-
tence: ‘‘Paragraph (1) of the first sentence of this sub-
section shall apply with respect to a colorectal cancer 
screening test regardless of the code that is billed for 
the establishment of a diagnosis as a result of the test, 
or for the removal of tissue or other matter or other 
procedure that is furnished in connection with, as a 
result of, and in the same clinical encounter as the 
screening test.’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to items and services furnished on or 
after January 1, 2011. 
SEC. 4105. EVIDENCE-BASED COVERAGE OF PREVENTIVE 
SERVICES IN MEDICARE. 
(a) AUTHORITY TO MODIFY OR ELIMINATE COVERAGE 
OF CERTAIN PREVENTIVE SERVICES.—Section 1834 of the 
Social Security Act (42 U.S.C. 1395m) is amended by add-
ing at the end the following new subsection:
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HR 3590 EAS/PP 
‘‘(n) AUTHORITY TO MODIFY OR ELIMINATE COV-
ERAGE
OF CERTAIN PREVENTIVE SERVICES.—Notwith-
standing any other provision of this title, effective begin-
ning on January 1, 2010, if the Secretary determines ap-
propriate, the Secretary may— 
‘‘(1) modify— 
‘‘(A) the coverage of any preventive service 
described 
in 
subparagraph 
(A) 
of 
section 
1861(ddd)(3) to the extent that such modification 
is consistent with the recommendations of the 
United States Preventive Services Task Force; 
and 
‘‘(B) the services included in the initial pre-
ventive physical examination described in sub-
paragraph (B) of such section; and 
‘‘(2) provide that no payment shall be made 
under this title for a preventive service described in 
subparagraph (A) of such section that has not re-
ceived a grade of A, B, C, or I by such Task Force.’’. 
(b) CONSTRUCTION.—Nothing in the amendment made 
by paragraph (1) shall be construed to affect the coverage 
of diagnostic or treatment services under title XVIII of the 
Social Security Act.
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SEC. 4106. IMPROVING ACCESS TO PREVENTIVE SERVICES 
FOR ELIGIBLE ADULTS IN MEDICAID. 
(a) CLARIFICATION OF INCLUSION OF SERVICES.—Sec-
tion 1905(a)(13) of the Social Security Act (42 U.S.C. 
1396d(a)(13)) is amended to read as follows: 
‘‘(13) other diagnostic, screening, preventive, and 
rehabilitative services, including— 
‘‘(A) any clinical preventive services that 
are assigned a grade of A or B by the United 
States Preventive Services Task Force; 
‘‘(B) with respect to an adult individual, 
approved vaccines recommended by the Advisory 
Committee on Immunization Practices (an advi-
sory committee established by the Secretary, act-
ing through the Director of the Centers for Dis-
ease Control and Prevention) and their adminis-
tration; and 
‘‘(C) any medical or remedial services (pro-
vided in a facility, a home, or other setting) rec-
ommended by a physician or other licensed prac-
titioner of the healing arts within the scope of 
their practice under State law, for the maximum 
reduction of physical or mental disability and 
restoration of an individual to the best possible 
functional level;’’.
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(b) INCREASED FMAP.—Section 1905(b) of the Social 
Security Act (42 U.S.C. 1396d(b)), as amended by sections 
2001(a)(3)(A) and 2004(c)(1), is amended in the first sen-
tence— 
(1) by striking ‘‘, and (4)’’ and inserting ‘‘, (4)’’; 
and 
(2) by inserting before the period the following: 
‘‘, and (5) in the case of a State that provides medical 
assistance for services and vaccines described in sub-
paragraphs (A) and (B) of subsection (a)(13), and 
prohibits cost-sharing for such services and vaccines, 
the Federal medical assistance percentage, as deter-
mined under this subsection and subsection (y) (with-
out regard to paragraph (1)(C) of such subsection), 
shall be increased by 1 percentage point with respect 
to medical assistance for such services and vaccines 
and for items and services described in subsection 
(a)(4)(D)’’. 
(c) EFFECTIVE DATE.—The amendments made under 
this section shall take effect on January 1, 2013. 
SEC. 4107. COVERAGE OF COMPREHENSIVE TOBACCO CES-
SATION SERVICES FOR PREGNANT WOMEN IN 
MEDICAID. 
(a) REQUIRING
COVERAGE
OF
COUNSELING
AND 
PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE BY
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PREGNANT WOMEN.—Section 1905 of the Social Security 
Act 
(42 
U.S.C. 
1396d), 
as 
amended 
by 
sections 
2001(a)(3)(B) and 2303, is further amended— 
(1) in subsection (a)(4)— 
(A) by striking ‘‘and’’ before ‘‘(C)’’; and 
(B) by inserting before the semicolon at the 
end the following new subparagraph: ‘‘; and (D) 
counseling and pharmacotherapy for cessation of 
tobacco use by pregnant women (as defined in 
subsection (bb))’’; and 
(2) by adding at the end the following: 
‘‘(bb)(1) For purposes of this title, the term ‘counseling 
and pharmacotherapy for cessation of tobacco use by preg-
nant women’ means diagnostic, therapy, and counseling 
services and pharmacotherapy (including the coverage of 
prescription and nonprescription tobacco cessation agents 
approved by the Food and Drug Administration) for ces-
sation of tobacco use by pregnant women who use tobacco 
products or who are being treated for tobacco use that is 
furnished— 
‘‘(A) by or under the supervision of a physician; 
or 
‘‘(B) by any other health care professional who— 
‘‘(i) is legally authorized to furnish such 
services under State law (or the State regulatory
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mechanism provided by State law) of the State 
in which the services are furnished; and 
‘‘(ii) is authorized to receive payment for 
other services under this title or is designated by 
the Secretary for this purpose. 
‘‘(2) Subject to paragraph (3), such term is limited 
to— 
‘‘(A) services recommended with respect to preg-
nant women in ‘Treating Tobacco Use and Depend-
ence: 2008 Update: A Clinical Practice Guideline’, 
published by the Public Health Service in May 2008, 
or any subsequent modification of such Guideline; 
and 
‘‘(B) such other services that the Secretary recog-
nizes to be effective for cessation of tobacco use by 
pregnant women. 
‘‘(3) Such term shall not include coverage for drugs 
or biologicals that are not otherwise covered under this 
title.’’. 
(b) EXCEPTION FROM OPTIONAL RESTRICTION UNDER 
MEDICAID
PRESCRIPTION
DRUG
COVERAGE.—Section 
1927(d)(2)(F) of the Social Security Act (42 U.S.C. 1396r– 
8(d)(2)(F)), as redesignated by section 2502(a), is amended 
by inserting before the period at the end the following: ‘‘, 
except, in the case of pregnant women when recommended
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in accordance with the Guideline referred to in section 
1905(bb)(2)(A), agents approved by the Food and Drug Ad-
ministration under the over-the-counter monograph process 
for purposes of promoting, and when used to promote, to-
bacco cessation’’. 
(c) REMOVAL
OF COST-SHARING
FOR COUNSELING 
AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE 
BY PREGNANT WOMEN.— 
(1) GENERAL COST-SHARING LIMITATIONS.—Sec-
tion 1916 of the Social Security Act (42 U.S.C. 
1396o) is amended in each of subsections (a)(2)(B) 
and (b)(2)(B) by inserting ‘‘, and counseling and 
pharmacotherapy for cessation of tobacco use by preg-
nant women (as defined in section 1905(bb)) and cov-
ered outpatient drugs (as defined in subsection (k)(2) 
of section 1927 and including nonprescription drugs 
described in subsection (d)(2) of such section) that are 
prescribed for purposes of promoting, and when used 
to promote, tobacco cessation by pregnant women in 
accordance with the Guideline referred to in section 
1905(bb)(2)(A)’’ after ‘‘complicate the pregnancy’’. 
(2) APPLICATION TO ALTERNATIVE COST-SHAR-
ING.—Section 1916A(b)(3)(B)(iii) of such Act (42 
U.S.C. 1396o–1(b)(3)(B)(iii)) is amended by insert-
ing ‘‘, and counseling and pharmacotherapy for ces-
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sation of tobacco use by pregnant women (as defined 
in section 1905(bb))’’ after ‘‘complicate the preg-
nancy’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on October 1, 2010. 
SEC. 4108. INCENTIVES FOR PREVENTION OF CHRONIC DIS-
EASES IN MEDICAID. 
(a) INITIATIVES.— 
(1) ESTABLISHMENT.— 
(A) IN
GENERAL.—The Secretary shall 
award grants to States to carry out initiatives 
to provide incentives to Medicaid beneficiaries 
who— 
(i) successfully participate in a pro-
gram described in paragraph (3); and 
(ii) upon completion of such participa-
tion, demonstrate changes in health risk 
and outcomes, including the adoption and 
maintenance of healthy behaviors by meet-
ing specific targets (as described in sub-
section (c)(2)). 
(B) PURPOSE.—The purpose of the initia-
tives under this section is to test approaches that 
may encourage behavior modification and deter-
mine scalable solutions.
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Service Act (42 U.S.C. 247b) is amended by adding at the 
end the following: 
‘‘(l) AUTHORITY TO PURCHASE RECOMMENDED VAC-
CINES FOR ADULTS.— 
‘‘(1) IN GENERAL.—The Secretary may negotiate 
and enter into contracts with manufacturers of vac-
cines for the purchase and delivery of vaccines for 
adults as provided for under subsection (e). 
‘‘(2) STATE
PURCHASE.—A State may obtain 
additional quantities of such adult vaccines (subject 
to amounts specified to the Secretary by the State in 
advance of negotiations) through the purchase of vac-
cines from manufacturers at the applicable price ne-
gotiated by the Secretary under this subsection.’’. 
(b) DEMONSTRATION PROGRAM TO IMPROVE IMMUNI-
ZATION COVERAGE.—Section 317 of the Public Health 
Service Act (42 U.S.C. 247b), as amended by subsection (a), 
is further amended by adding at the end the following: 
‘‘(m) DEMONSTRATION PROGRAM TO IMPROVE IMMU-
NIZATION COVERAGE.— 
‘‘(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Director of the Centers for Disease Con-
trol and Prevention, shall establish a demonstration 
program to award grants to States to improve the 
provision of recommended immunizations for chil-
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‘‘(i) has received specialized training 
or clinical experience in child and adoles-
cent mental health in psychiatry, psy-
chology, school psychology, behavioral pedi-
atrics, psychiatric nursing, social work, 
school social work, substance abuse disorder 
prevention and treatment, marriage and 
family therapy, school counseling, or profes-
sional counseling; 
‘‘(ii) has a license or certification in a 
State to practice allopathic medicine, osteo-
pathic medicine, psychology, school psy-
chology, psychiatric nursing, social work, 
school social work, marriage and family 
therapy, school counseling, or professional 
counseling; or 
‘‘(iii) is a mental health service profes-
sional who completed (but not before the end 
of the calendar year in which this section is 
enacted) specialized training or clinical ex-
perience in child and adolescent mental 
health described in clause (i). 
‘‘(2) ADDITIONAL ELIGIBILITY REQUIREMENTS.— 
The Secretary may not enter into a contract under 
this subsection with an eligible individual unless—