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local funds that would otherwise be expended by such entity 
to carry out the activities described in this section. 
‘‘(h) MAINTENANCE OF EFFORT.—With respect to ac-
tivities for which funds awarded under this section are to 
be expended, the entity shall agree to maintain expenditures 
of non-Federal amounts for such activities at a level that 
is not less than the level of such expenditures maintained 
by the entity for the fiscal year preceding the fiscal year 
for which the entity receives a grant under this section. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated $4,000,000 for each of the 
fiscal years 2010 through 2013.’’. 
(m)(1) Section 768 of the Public Health Service Act 
(42 U.S.C. 295c) is amended to read as follows: 
‘‘SEC. 768. PREVENTIVE MEDICINE AND PUBLIC HEALTH 
TRAINING GRANT PROGRAM. 
‘‘(a) GRANTS.—The Secretary, acting through the Ad-
ministrator of the Health Resources and Services Adminis-
tration and in consultation with the Director of the Centers 
for Disease Control and Prevention, shall award grants to, 
or enter into contracts with, eligible entities to provide 
training to graduate medical residents in preventive medi-
cine specialties. 
‘‘(b) ELIGIBILITY.—To be eligible for a grant or con-
tract under subsection (a), an entity shall be— 
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‘‘(1) an accredited school of public health or 
school of medicine or osteopathic medicine; 
‘‘(2) an accredited public or private nonprofit 
hospital; 
‘‘(3) a State, local, or tribal health department; 
or 
‘‘(4) a consortium of 2 or more entities described 
in paragraphs (1) through (3). 
‘‘(c) USE OF FUNDS.—Amounts received under a grant 
or contract under this section shall be used to— 
‘‘(1) plan, develop (including the development of 
curricula), operate, or participate in an accredited 
residency or internship program in preventive medi-
cine or public health; 
‘‘(2) defray the costs of practicum experiences, as 
required in such a program; and 
‘‘(3) establish, maintain, or improve— 
‘‘(A) academic administrative units (in-
cluding departments, divisions, or other appro-
priate units) in preventive medicine and public 
health; or 
‘‘(B) programs that improve clinical teach-
ing in preventive medicine and public health. 
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‘‘(d) REPORT.—The Secretary shall submit to the Con-
gress an annual report on the program carried out under 
this section.’’. 
(2) Section 770(a) of the Public Health Service 
Act (42 U.S.C. 295e(a)) is amended to read as fol-
lows: 
‘‘(a) IN GENERAL.—For the purpose of carrying out 
this subpart, there is authorized to be appropriated 
$43,000,000 for fiscal year 2011, and such sums as may 
be necessary for each of the fiscal years 2012 through 
2015.’’. 
(n)(1) Subsection (i) of section 331 of the Public 
Health Service Act (42 U.S.C. 254d) of the Public Health 
Service Act is amended— 
(A) in paragraph (1), by striking ‘‘In carrying 
out subpart III’’ and all that follows through the pe-
riod and inserting ‘‘In carrying out subpart III, the 
Secretary may, in accordance with this subsection, 
issue waivers to individuals who have entered into a 
contract for obligated service under the Scholarship 
Program or the Loan Repayment Program under 
which the individuals are authorized to satisfy the re-
quirement of obligated service through providing clin-
ical practice that is half time.’’; 
(B) in paragraph (2)— 
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(i) in subparagraphs (A)(ii) and (B), by 
striking ‘‘less than full time’’ each place it ap-
pears and inserting ‘‘half time’’; 
(ii) in subparagraphs (C) and (F), by strik-
ing ‘‘less than full-time service’’ each place it ap-
pears and inserting ‘‘half-time service’’; and 
(iii) by amending subparagraphs (D) and 
(E) to read as follows: 
‘‘(D) the entity and the Corps member agree in 
writing that the Corps member will perform half-time 
clinical practice; 
‘‘(E) the Corps member agrees in writing to ful-
fill all of the service obligations under section 338C 
through half-time clinical practice and either— 
‘‘(i) double the period of obligated service 
that would otherwise be required; or 
‘‘(ii) in the case of contracts entered into 
under section 338B, accept a minimum service 
obligation of 2 years with an award amount 
equal to 50 percent of the amount that would 
otherwise be payable for full-time service; and’’; 
and 
(C) in paragraph (3), by striking ‘‘In evaluating 
a demonstration project described in paragraph (1)’’ 
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and inserting ‘‘In evaluating waivers issued under 
paragraph (1)’’. 
(2) Subsection (j) of section 331 of the Public Health 
Service Act (42 U.S.C. 254d) is amended by adding at the 
end the following: 
‘‘(5) The terms ‘full time’ and ‘full-time’ mean a 
minimum of 40 hours per week in a clinical practice, 
for a minimum of 45 weeks per year. 
‘‘(6) The terms ‘half time’ and ‘half-time’ mean 
a minimum of 20 hours per week (not to exceed 39 
hours per week) in a clinical practice, for a min-
imum of 45 weeks per year.’’. 
(3) Section 337(b)(1) of the Public Health Service Act 
(42 U.S.C. 254j(b)(1)) is amended by striking ‘‘Members 
may not be reappointed to the Council.’’. 
(4) Section 338B(g)(2)(A) of the Public Health Service 
Act (42 U.S.C. 254l–1(g)(2)(A)) is amended by striking 
‘‘$35,000’’ and inserting ‘‘$50,000, plus, beginning with fis-
cal year 2012, an amount determined by the Secretary on 
an annual basis to reflect inflation,’’. 
(5) Subsection (a) of section 338C of the Public Health 
Service Act (42 U.S.C. 254m), as amended by section 5508, 
is amended— 
(A) by striking the second sentence and inserting 
the following: ‘‘The Secretary may treat teaching as 
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clinical practice for up to 20 percent of such period 
of obligated service.’’; and 
(B) by adding at the end the following: ‘‘Not-
withstanding the preceding sentence, with respect to a 
member of the Corps participating in the teaching 
health centers graduate medical education program 
under section 340H, for the purpose of calculating 
time spent in full-time clinical practice under this 
section, up to 50 percent of time spent teaching by 
such member may be counted toward his or her serv-
ice obligation.’’. 
SEC. 10502. INFRASTRUCTURE TO EXPAND ACCESS TO 
CARE. 
(a) APPROPRIATION.—There are authorized to be ap-
propriated, and there are appropriated to the Department 
of Health and Human Services, $100,000,000 for fiscal year 
2010, to remain available for obligation until September 
30, 2011, to be used for debt service on, or direct construc-
tion or renovation of, a health care facility that provides 
research, inpatient tertiary care, or outpatient clinical serv-
ices. Such facility shall be affiliated with an academic 
health center at a public research university in the United 
States that contains a State’s sole public academic medical 
and dental school. 
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(b) REQUIREMENT.—Amount appropriated under sub-
section (a) may only be made available by the Secretary 
of Health and Human Services upon the receipt of an ap-
plication from the Governor of a State that certifies that— 
(1) the new health care facility is critical for the 
provision of greater access to health care within the 
State; 
(2) such facility is essential for the continued fi-
nancial viability of the State’s sole public medical 
and dental school and its academic health center; 
(3) the request for Federal support represents not 
more than 40 percent of the total cost of the proposed 
new facility; and 
(4) the State has established a dedicated funding 
mechanism to provide all remaining funds necessary 
to complete the construction or renovation of the pro-
posed facility. 
SEC. 10503. COMMUNITY HEALTH CENTERS AND THE NA-
TIONAL HEALTH SERVICE CORPS FUND. 
(a) PURPOSE.—It is the purpose of this section to es-
tablish a Community Health Center Fund (referred to in 
this section as the ‘‘CHC Fund’’), to be administered 
through the Office of the Secretary of the Department of 
Health and Human Services to provide for expanded and 
sustained national investment in community health centers 
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under section 330 of the Public Health Service Act and the 
National Health Service Corps. 
(b) FUNDING.—There is authorized to be appropriated, 
and there is appropriated, out of any monies in the Treas-
ury not otherwise appropriated, to the CHC Fund— 
(1) to be transferred to the Secretary of Health 
and Human Services to provide enhanced funding for 
the community health center program under section 
330 of the Public Health Service Act— 
(A) $700,000,000 for fiscal year 2011; 
(B) $800,000,000 for fiscal year 2012; 
(C) $1,000,000,000 for fiscal year 2013; 
(D) $1,600,000,000 for fiscal year 2014; 
and 
(E) $2,900,000,000 for fiscal year 2015; 
and 
(2) to be transferred to the Secretary of Health 
and Human Services to provide enhanced funding for 
the National Health Service Corps— 
(A) $290,000,000 for fiscal year 2011; 
(B) $295,000,000 for fiscal year 2012; 
(C) $300,000,000 for fiscal year 2013; 
(D) $305,000,000 for fiscal year 2014; and 
(E) $310,000,000 for fiscal year 2015. 
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(c) CONSTRUCTION.—There is authorized to be appro-
priated, and there is appropriated, out of any monies in 
the Treasury not otherwise appropriated, $1,500,000,000 to 
be available for fiscal years 2011 through 2015 to be used 
by the Secretary of Health and Human Services for the con-
struction and renovation of community health centers. 
(d) USE OF FUND.—The Secretary of Health and 
Human Services shall transfer amounts in the CHC Fund 
to accounts within the Department of Health and Human 
Services to increase funding, over the fiscal year 2008 level, 
for community health centers and the National Health 
Service Corps. 
(e) AVAILABILITY.—Amounts appropriated under sub-
sections (b) and (c) shall remain available until expended. 
SEC. 10504. DEMONSTRATION PROJECT TO PROVIDE AC-
CESS TO AFFORDABLE CARE. 
(a) IN GENERAL.—Not later than 6 months after the 
date of enactment of this Act, the Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’), acting through the Health Resources and Services 
Administration, shall establish a 3 year demonstration 
project in up to 10 States to provide access to comprehensive 
health care services to the uninsured at reduced fees. The 
Secretary shall evaluate the feasibility of expanding the 
project to additional States. 
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(b) ELIGIBILITY.—To be eligible to participate in the 
demonstration project, an entity shall be a State-based, 
nonprofit, public-private partnership that provides access 
to comprehensive health care services to the uninsured at 
reduced fees. Each State in which a participant selected by 
the Secretary is located shall receive not more than 
$2,000,000 to establish and carry out the project for the 3- 
year demonstration period. 
(c) AUTHORIZATION.—There is authorized to be appro-
priated such sums as may be necessary to carry out this 
section. 
Subtitle F—Provisions Relating to 
Title VI 
SEC. 10601. REVISIONS TO LIMITATION ON MEDICARE EX-
CEPTION TO THE PROHIBITION ON CERTAIN 
PHYSICIAN REFERRALS FOR HOSPITALS. 
(a) IN GENERAL.—Section 1877(i) of the Social Secu-
rity Act, as added by section 6001(a), is amended— 
(1) in paragraph (1)(A)(i), by striking ‘‘Feb-
ruary 1, 2010’’ and inserting ‘‘August 1, 2010’’; and 
(2) in paragraph (3)(A)— 
(A) in clause (iii), by striking ‘‘August 1, 
2011’’ and inserting ‘‘February 1, 2012’’; and 
(B) in clause (iv), by striking ‘‘July 1, 
2011’’ and inserting ‘‘January 1, 2012’’. 
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(b) CONFORMING AMENDMENT.—Section 6001(b)(2) of 
this Act is amended by striking ‘‘November 1, 2011’’ and 
inserting ‘‘May 1, 2012’’. 
SEC. 10602. CLARIFICATIONS TO PATIENT-CENTERED OUT-
COMES RESEARCH. 
Section 1181 of the Social Security Act (as added by 
section 6301) is amended— 
(1) in subsection (d)(2)(B)— 
(A) in clause (ii)(IV)— 
(i) by inserting ‘‘, as described in sub-
paragraph (A)(ii),’’ after ‘‘original re-
search’’; and 
(ii) by inserting ‘‘, as long as the re-
searcher enters into a data use agreement 
with the Institute for use of the data from 
the original research, as appropriate’’ after 
‘‘publication’’; and 
(B) by amending clause (iv) to read as fol-
lows: 
‘‘(iv) 
SUBSEQUENT
USE
OF
THE 
DATA.—The Institute shall not allow the 
subsequent use of data from original re-
search in work-for-hire contracts with indi-
viduals, entities, or instrumentalities that 
have a financial interest in the results, un-
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less approved under a data use agreement 
with the Institute.’’; 
(2) in subsection (d)(8)(A)(iv), by striking ‘‘not 
be construed as mandates for’’ and inserting ‘‘do not 
include’’; and 
(3) in subsection (f)(1)(C), by amending clause 
(ii) to read as follows: 
‘‘(ii) 7 members representing physi-
cians and providers, including 4 members 
representing physicians (at least 1 of whom 
is a surgeon), 1 nurse, 1 State-licensed inte-
grative health care practitioner, and 1 rep-
resentative of a hospital.’’. 
SEC. 10603. STRIKING PROVISIONS RELATING TO INDI-
VIDUAL PROVIDER APPLICATION FEES. 
(a) IN GENERAL.—Section 1866(j)(2)(C) of the Social 
Security Act, as added by section 6401(a), is amended— 
(1) by striking clause (i); 
(2) by redesignating clauses (ii) through (iv), re-
spectively, as clauses (i) through (iii); and 
(3) in clause (i), as redesignated by paragraph 
(2), by striking ‘‘clause (iii)’’ and inserting ‘‘clause 
(ii)’’. 
(b) TECHNICAL CORRECTION.—Section 6401(a)(2) of 
this Act is amended to read as follows: 
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‘‘(2) by redesignating paragraph (2) as para-
graph (8); and’’. 
SEC. 10604. TECHNICAL CORRECTION TO SECTION 6405. 
Paragraphs (1) and (2) of section 6405(b) are amend-
ed to read as follows: 
‘‘(1) PART A.—Section 1814(a)(2) of the Social 
Security Act (42 U.S.C. 1395(a)(2)) is amended in 
the matter preceding subparagraph (A) by inserting 
‘, or, in the case of services described in subparagraph 
(C), a physician enrolled under section 1866(j),’ after 
‘in collaboration with a physician,’. 
‘‘(2) PART B.—Section 1835(a)(2) of the Social 
Security Act (42 U.S.C. 1395n(a)(2)) is amended in 
the matter preceding subparagraph (A) by inserting 
‘, or, in the case of services described in subparagraph 
(A), a physician enrolled under section 1866(j),’ after 
‘a physician’.’’. 
SEC. 10605. CERTAIN OTHER PROVIDERS PERMITTED TO 
CONDUCT FACE TO FACE ENCOUNTER FOR 
HOME HEALTH SERVICES. 
(a) PART A.—Section 1814(a)(2)(C) of the Social Se-
curity Act (42 U.S.C. 1395f(a)(2)(C)), as amended by sec-
tion 6407(a)(1), is amended by inserting ‘‘, or a nurse prac-
titioner or clinical nurse specialist (as those terms are de-
fined in section 1861(aa)(5)) who is working in collabora-
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tion with the physician in accordance with State law, or 
a certified nurse-midwife (as defined in section 1861(gg)) 
as authorized by State law, or a physician assistant (as 
defined in section 1861(aa)(5)) under the supervision of the 
physician,’’ after ‘‘himself or herself’’. 
(b) PART B.—Section 1835(a)(2)(A)(iv) of the Social 
Security Act, as added by section 6407(a)(2), is amended 
by inserting ‘‘, or a nurse practitioner or clinical nurse spe-
cialist (as those terms are defined in section 1861(aa)(5)) 
who is working in collaboration with the physician in ac-
cordance with State law, or a certified nurse-midwife (as 
defined in section 1861(gg)) as authorized by State law, or 
a physician assistant (as defined in section 1861(aa)(5)) 
under the supervision of the physician,’’ after ‘‘must docu-
ment that the physician’’. 
SEC. 10606. HEALTH CARE FRAUD ENFORCEMENT. 
(a) FRAUD SENTENCING GUIDELINES.— 
(1) DEFINITION.—In this subsection, the term 
‘‘Federal health care offense’’ has the meaning given 
that term in section 24 of title 18, United States 
Code, as amended by this Act. 
(2) REVIEW
AND
AMENDMENTS.—Pursuant to 
the authority under section 994 of title 28, United 
States Code, and in accordance with this subsection, 
the United States Sentencing Commission shall— 
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(A) review the Federal Sentencing Guide-
lines and policy statements applicable to persons 
convicted of Federal health care offenses; 
(B) amend the Federal Sentencing Guide-
lines and policy statements applicable to persons 
convicted of Federal health care offenses involv-
ing Government health care programs to provide 
that the aggregate dollar amount of fraudulent 
bills submitted to the Government health care 
program shall constitute prima facie evidence of 
the amount of the intended loss by the defendant; 
and 
(C) amend the Federal Sentencing Guide-
lines to provide— 
(i) a 2-level increase in the offense level 
for any defendant convicted of a Federal 
health care offense relating to a Government 
health care program which involves a loss of 
not less than $1,000,000 and less than 
$7,000,000; 
(ii) a 3-level increase in the offense 
level for any defendant convicted of a Fed-
eral health care offense relating to a Gov-
ernment health care program which involves 
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a loss of not less than $7,000,000 and less 
than $20,000,000; 
(iii) a 4-level increase in the offense 
level for any defendant convicted of a Fed-
eral health care offense relating to a Gov-
ernment health care program which involves 
a loss of not less than $20,000,000; and 
(iv) if appropriate, otherwise amend 
the Federal Sentencing Guidelines and pol-
icy statements applicable to persons con-
victed of Federal health care offenses involv-
ing Government health care programs. 
(3) REQUIREMENTS.—In carrying this sub-
section, the United States Sentencing Commission 
shall— 
(A) ensure that the Federal Sentencing 
Guidelines and policy statements— 
(i) reflect the serious harms associated 
with health care fraud and the need for ag-
gressive and appropriate law enforcement 
action to prevent such fraud; and 
(ii) provide increased penalties for per-
sons convicted of health care fraud offenses 
in appropriate circumstances; 
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(B) consult with individuals or groups rep-
resenting health care fraud victims, law enforce-
ment officials, the health care industry, and the 
Federal judiciary as part of the review described 
in paragraph (2); 
(C) ensure reasonable consistency with other 
relevant directives and with other guidelines 
under the Federal Sentencing Guidelines; 
(D) account for any aggravating or miti-
gating circumstances that might justify excep-
tions, including circumstances for which the Fed-
eral Sentencing Guidelines, as in effect on the 
date of enactment of this Act, provide sentencing 
enhancements; 
(E) make any necessary conforming changes 
to the Federal Sentencing Guidelines; and 
(F) ensure that the Federal Sentencing 
Guidelines adequately meet the purposes of sen-
tencing. 
(b) INTENT
REQUIREMENT
FOR
HEALTH
CARE 
FRAUD.—Section 1347 of title 18, United States Code, is 
amended— 
(1) by inserting ‘‘(a)’’ before ‘‘Whoever know-
ingly’’; and 
(2) by adding at the end the following: 
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substituting ‘calendar year 2009’ for ‘calendar 
year 1992’ in subparagraph (B) thereof. 
If any amount as increased under the preceding sen-
tence is not a multiple of $10, such amount shall be 
rounded to the nearest multiple of $10. 
‘‘(2) INCOME LIMITATION.—In the case of a tax-
able year beginning after December 31, 2002, the dol-
lar amount in subsection (b)(2)(A)(i) shall be in-
creased by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar year 
in which the taxable year begins, determined by 
substituting ‘calendar year 2001’ for ‘calendar 
year 1992’ in subparagraph (B) thereof. 
If any amount as increased under the preceding sen-
tence is not a multiple of $10, such amount shall be 
rounded to the nearest multiple of $10.’’. 
(2) ADOPTION ASSISTANCE PROGRAMS.— 
(A) IN GENERAL.—Paragraph (1) of section 
137(b) of the Internal Revenue Code of 1986 (re-
lating to dollar limitation) is amended by strik-
ing ‘‘$10,000’’ and inserting ‘‘$13,170’’. 
(B) CHILD WITH SPECIAL NEEDS.—Para-
graph (2) of section 137(a) of such Code (relat-
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