H. R. 3590—392 
into account discoveries from clinical research and 
comparative effectiveness research; 
‘‘(F) allow communication of research findings and 
translate evidence into practice recommendations that are 
adaptable to a variety of settings, and which, as soon 
as practicable after the establishment of the Center, shall 
include— 
‘‘(i) the implementation of a national application 
of Intensive Care Unit improvement projects relating 
to the adult (including geriatric), pediatric, and neo-
natal patient populations; 
‘‘(ii) practical methods for addressing health care 
associated infections, including Methicillin-Resistant 
Staphylococcus 
Aureus 
and 
Vancomycin-Resistant 
Entercoccus infections and other emerging infections; 
and 
‘‘(iii) practical methods for reducing preventable 
hospital admissions and readmissions; 
‘‘(G) expand demonstration projects for improving the 
quality of children’s health care and the use of health 
information technology, such as through Pediatric Quality 
Improvement Collaboratives and Learning Networks, con-
sistent with provisions of section 1139A of the Social Secu-
rity Act for assessing and improving quality, where 
applicable; 
‘‘(H) identify and mitigate hazards by— 
‘‘(i) analyzing events reported to patient safety 
reporting systems and patient safety organizations; 
and 
‘‘(ii) using the results of such analyses to develop 
scientific methods of response to such events; 
‘‘(I) include the conduct of systematic reviews of 
existing practices that improve the quality, safety, and 
efficiency of health care delivery, as well as new research 
on improving such practices; and 
‘‘(J) include the examination of how to measure and 
evaluate the progress of quality and patient safety activi-
ties. 
‘‘(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 providers and consumers and diverse levels 
of health literacy. 
‘‘(2) LINKAGE TO HEALTH INFORMATION TECHNOLOGY.—The 
Secretary shall ensure that research findings and results gen-
erated 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 exten-
sion program under section 3012, as well as any relevant stand-
ards, certification criteria, or implementation 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 experience;
H. R. 3590—393 
‘‘(3) provider assessment of such processes or systems and 
opportunities to minimize distress and injury to the health 
care workforce; 
‘‘(4) the potential impact of such processes or systems on 
health status and function of patients, including vulnerable 
populations including children; 
‘‘(5) the areas of insufficient evidence identified under sub-
section (c)(2)(B); and 
‘‘(6) the evolution of meaningful use of health information 
technology, as defined in section 3000. 
‘‘(f) COORDINATION.—The Center shall coordinate its activities 
with activities conducted by the Center for Medicare and Medicaid 
Innovation established under section 1115A of the Social Security 
Act. 
‘‘(g) FUNDING.—There is authorized to be appropriated to carry 
out this section $20,000,000 for fiscal years 2010 through 2014. 
‘‘SEC. 934. QUALITY IMPROVEMENT TECHNICAL ASSISTANCE 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 enti-
ties to provide technical support to institutions that deliver 
health care and health care providers (including rural and 
urban providers of services and suppliers with limited infra-
structure and financial 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 institutions and providers 
understand, adapt, and implement the models and practices 
identified in the research conducted by the Center, including 
the Quality Improvement Networks Research Program; and 
‘‘(2) implementation grants or contracts to eligible entities 
to implement the models and practices described under para-
graph (1). 
‘‘(b) ELIGIBLE ENTITIES.— 
‘‘(1) TECHNICAL
ASSISTANCE
AWARD.—To be eligible to 
receive a technical assistance grant or contract 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 improve-
ment organization, patient safety organization, local quality 
improvement collaborative, the Joint Commission, aca-
demic health center, university, physician-based research 
network, primary care extension program established under 
section 399W, a Federal Indian Health Service program 
or a health program operated by an Indian tribe (as defined 
in section 4 of the Indian Health Care Improvement 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.
H. R. 3590—394 
‘‘(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 determined 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 receive 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 popu-
lations; and 
‘‘(B) such other information as the Director may 
require. 
‘‘(2) IMPLEMENTATION AWARD.—To receive a grant or con-
tract 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 requirements, and 
timeline for implementation; and 
‘‘(ii) pre- and projected post-implementation 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 entities) 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 or contract. Such non-Federal matching funds 
may be provided directly or through donations from public or private 
entities and may be in cash or in-kind, fairly evaluated, including 
plant, equipment, or services. 
‘‘(e) EVALUATION.— 
‘‘(1) IN GENERAL.—The Director shall evaluate the perform-
ance of each entity that receives a grant or contract under 
this section. The evaluation of an entity shall include a study 
of— 
‘‘(A) the success of such entity in achieving the 
implementation, by the health care institutions and pro-
viders assisted by such entity, of the models and practices 
identified in the research conducted by the Center under 
section 933;
H. R. 3590—395 
‘‘(B) the perception of the health care institutions and 
providers assisted by such entity regarding the value of 
the entity; and 
‘‘(C) where practicable, better patient health outcomes 
and lower cost resulting from the assistance provided by 
such entity. 
‘‘(2) EFFECT
OF
EVALUATION.—Based on the outcome of 
the evaluation of the entity under paragraph (1), the Director 
shall determine whether to renew a grant or contract with 
such entity under this section. 
‘‘(f) COORDINATION.—The entities that receive a grant or con-
tract 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 ‘‘Secretary’’) shall establish a 
program to provide grants to or enter into contracts with eligible 
entities to establish community-based interdisciplinary, interprofes-
sional 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. 
(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 Improvement Act; 
(2) submit a plan for achieving long-term financial sustain-
ability within 3 years; 
(3) submit a plan for incorporating prevention initiatives 
and patient education and care management 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, nutrition-
ists, dieticians, social workers, behavioral and mental health 
providers (including substance use disorder prevention and 
treatment providers), doctors of chiropractic, licensed com-
plementary and alternative medicine practitioners, and physi-
cians’ assistants; 
(5) agree to provide services to eligible individuals with 
chronic conditions, as described in section 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
H. R. 3590—396 
(6) submit to the Secretary an application at such time, 
in such manner, and containing such information as the Sec-
retary may require. 
(c) REQUIREMENTS FOR HEALTH TEAMS.—A health team estab-
lished pursuant to a grant or contract under subsection (a) shall— 
(1) establish contractual agreements with primary care pro-
viders to provide support services; 
(2) support patient-centered medical homes, defined 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 evidence- 
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 addi-
tional components of patient-centered care; 
(3) collaborate with local primary care providers and 
existing State and community based resources to coordinate 
disease prevention, chronic disease management, transitioning 
between health care providers and settings and case manage-
ment for patients, including children, with priority given to 
those amenable to prevention and with chronic diseases or 
conditions identified by the Secretary; 
(4) in collaboration with local health care providers, 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 Secretary; 
(5) incorporate health care providers, patients, caregivers, 
and authorized representatives in program design and over-
sight; 
(6) provide support necessary for local primary care pro-
viders to— 
(A) coordinate and provide access to high-quality health 
care services; 
(B) coordinate and provide access to preventive and 
health promotion services; 
(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 com-
plementary and alternative (CAM) services to those who 
request such services; 
(G) promote effective strategies for treatment planning, 
monitoring health outcomes and resource use, sharing 
information, treatment decision support, and organizing 
care to avoid duplication of service and other medical 
management 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 setting, including
H. R. 3590—397 
access to individuals that implement the care plans of 
patients and coordinate care, such as integrative health 
care practitioners; 
(I) collect and report data that permits evaluation of 
the success of the collaborative effort on patient outcomes, 
including collection of data on patient experience of care, 
and identification of areas for improvement; and 
(J) establish a coordinated system of early identifica-
tion 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 deter-
mined by the Secretary; 
(7) provide 24-hour care management and support during 
transitions in care settings including— 
(A) a transitional care program that provides onsite 
visits from the care coordinator, assists with the develop-
ment 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 support to pro-
viders, patients, caregivers, and authorized representatives; 
(C) assuring that post-discharge care plans include 
medication management, as appropriate; 
(D) referrals for mental and behavioral health services, 
which may include the use of infolines; and 
(E) transitional health care needs from adolescence 
to adulthood; 
(8) serve as a liaison to community prevention and treat-
ment programs; 
(9) demonstrate a capacity to implement and maintain 
health information technology that meets the requirements of 
certified EHR technology (as defined 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 information 
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. 
(e) REPORTING TO SECRETARY.—An entity that receives 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 accountable for addressing a 
large majority of personal health care needs, developing a sustained 
partnership with patients, and practicing in the context of family 
and community.
H. R. 3590—398 
SEC. 3503. MEDICATION MANAGEMENT SERVICES IN TREATMENT 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 amended by inserting 
after section 934 the following: 
‘‘SEC. 935. GRANTS OR CONTRACTS TO IMPLEMENT MEDICATION 
MANAGEMENT SERVICES IN TREATMENT 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 section as ‘MTM’) services provided 
by licensed pharmacists, as a collaborative, multidisciplinary, inter- 
professional 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 com-
mence 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 coordinating MTM 
services through local community health teams established in 
section 3502 of the Patient Protection 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 information as 
the Secretary may require. 
‘‘(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 assessments of the 
health and functional status of each patient 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, recommending 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, including safety and 
effectiveness; 
‘‘(5) performing an initial comprehensive medication review 
to identify, resolve, and prevent medication-related problems, 
including adverse drug events, quarterly targeted medication 
reviews for ongoing monitoring, and additional followup inter-
ventions on a schedule developed collaboratively with the pre-
scriber;
H. R. 3590—399 
‘‘(6) documenting the care delivered and communicating 
essential information about such care, including a summary 
of the medication review, and the recommendations of the 
pharmacist to other appropriate 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 patient 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 phar-
macist scopes of practice in use in other Federal programs 
that have implemented MTM services. 
‘‘(d) TARGETED
INDIVIDUALS.—MTM services provided by 
licensed pharmacists under a grant or contract awarded under 
subsection (a) shall be offered to targeted individuals who— 
‘‘(1) take 4 or more prescribed medications (including over- 
the-counter medications and dietary supplements); 
‘‘(2) take any ‘high risk’ medications; 
‘‘(3) have 2 or more chronic diseases, as identified 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 problems. 
‘‘(e) CONSULTATION WITH EXPERTS.—In designing and imple-
menting 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 organizations, health care organizations, consumer 
advocates, chronic disease groups, and other stakeholders involved 
with the research, dissemination, and implementation of phar-
macist-delivered MTM services, as the Secretary determines appro-
priate. The Secretary, in collaboration with this group, shall deter-
mine whether it is possible to incorporate rapid cycle process 
improvement concepts in use in other Federal programs that have 
implemented MTM services. 
‘‘(f) REPORTING TO THE SECRETARY.—An entity that receives 
a grant or contract under subsection (a) shall submit to the Sec-
retary 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 Social Security Act, as determined by the Sec-
retary. 
‘‘(g) EVALUATION AND REPORT.—The Secretary shall submit to 
the relevant committees of Congress a report which shall— 
‘‘(1) assess the clinical effectiveness of pharmacist-provided 
services under the MTM services program, as compared to 
usual care, including an evaluation of whether enrollees main-
tained better health with fewer hospitalizations and emergency 
room visits than similar patients not enrolled in the program; 
‘‘(2) assess changes in overall health care resource use 
by targeted individuals;
H. R. 3590—400 
‘‘(3) assess patient and prescriber satisfaction with MTM 
services; 
‘‘(4) assess the impact of patient-cost sharing requirements 
on medication adherence and recommendations for modifica-
tions; 
‘‘(5) identify and evaluate other factors that may impact 
clinical 
and 
economic 
outcomes, 
including 
demographic 
characteristics, clinical characteristics, and health services use 
of the patient, as well as characteristics of the regimen, phar-
macy 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 recommendations 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 manage-
ment services.’’. 
SEC. 3504. DESIGN AND IMPLEMENTATION OF REGIONALIZED SYS-
TEMS FOR EMERGENCY CARE. 
(a) IN GENERAL.—Title XII of the Public Health Service Act 
(42 U.S.C. 300d et seq.) is amended— 
(1) in section 1203— 
(A) in the section heading, by inserting ‘‘FOR TRAUMA 
SYSTEMS’’ after ‘‘GRANTS’’; and 
(B) in subsection (a), by striking ‘‘Administrator of 
the Health Resources and Services Administration’’ and 
inserting ‘‘Assistant Secretary for Preparedness and 
Response’’; 
(2) by inserting after section 1203 the following: 
‘‘SEC. 1204. COMPETITIVE GRANTS FOR REGIONALIZED SYSTEMS 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 design, implement, and evaluate 
innovative models of regionalized, comprehensive, and accountable 
emergency care and trauma systems. 
‘‘(b) ELIGIBLE ENTITY; REGION.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible entity’ 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. 
‘‘(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 Sec-
retary. 
‘‘(3) EMERGENCY SERVICES.—The term ‘emergency services’ 
includes acute, prehospital, and trauma care.