567 
•AMDT. NO. 2786 
or Urban Indian Organization (as de-
fined in section 1139(c)).’’. 
(d) TECHNICAL CORRECTIONS.—Section 1139(c) of 
the Social Security Act (42 U.S.C. 1320b–9(c)) is amend-
ed by striking ‘‘In this section’’ and inserting ‘‘For pur-
poses of this section, title XIX, and title XXI’’. 
SEC. 2902. ELIMINATION OF SUNSET FOR REIMBURSEMENT 
FOR ALL MEDICARE PART B SERVICES FUR-
NISHED BY CERTAIN INDIAN HOSPITALS AND 
CLINICS. 
(a) REIMBURSEMENT FOR ALL MEDICARE PART B 
SERVICES FURNISHED BY CERTAIN INDIAN HOSPITALS 
AND CLINICS.—Section 1880(e)(1)(A) of the Social Secu-
rity Act (42 U.S.C. 1395qq(e)(1)(A)) is amended by strik-
ing ‘‘during the 5-year period beginning on’’ and inserting 
‘‘on or after’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items or services furnished on 
or after January 1, 2010. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00567
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
568 
•AMDT. NO. 2786 
Subtitle L—Maternal and Child 
Health Services 
SEC. 2951. MATERNAL, INFANT, AND EARLY CHILDHOOD 
HOME VISITING PROGRAMS. 
Title V of the Social Security Act (42 U.S.C. 701 
et seq.) is amended by adding at the end the following 
new section: 
‘‘SEC. 511. MATERNAL, INFANT, AND EARLY CHILDHOOD 
HOME VISITING PROGRAMS. 
‘‘(a) PURPOSES.—The purposes of this section are— 
‘‘(1) to strengthen and improve the programs 
and activities carried out under this title; 
‘‘(2) to improve coordination of services for at 
risk communities; and 
‘‘(3) to identify and provide comprehensive 
services to improve outcomes for families who reside 
in at risk communities. 
‘‘(b) REQUIREMENT FOR ALL STATES TO ASSESS 
STATEWIDE NEEDS
AND IDENTIFY
AT RISK COMMU-
NITIES.— 
‘‘(1) IN GENERAL.—Not later than 6 months 
after the date of enactment of this section, each 
State shall, as a condition of receiving payments 
from an allotment for the State under section 502 
for fiscal year 2011, conduct a statewide needs as-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00568
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
569 
•AMDT. NO. 2786 
sessment (which shall be separate from the statewide 
needs assessment required under section 505(a)) 
that identifies— 
‘‘(A) communities with concentrations of— 
‘‘(i) premature birth, low-birth weight 
infants, and infant mortality, including in-
fant death due to neglect, or other indica-
tors of at-risk prenatal, maternal, newborn, 
or child health; 
‘‘(ii) poverty; 
‘‘(iii) crime; 
‘‘(iv) domestic violence; 
‘‘(v) high rates of high-school drop- 
outs; 
‘‘(vi) substance abuse; 
‘‘(vii) unemployment; or 
‘‘(viii) child maltreatment; 
‘‘(B) the quality and capacity of existing 
programs or initiatives for early childhood home 
visitation in the State including— 
‘‘(i) the number and types of individ-
uals and families who are receiving services 
under such programs or initiatives; 
‘‘(ii) the gaps in early childhood home 
visitation in the State; and 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00569
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
570 
•AMDT. NO. 2786 
‘‘(iii) the extent to which such pro-
grams or initiatives are meeting the needs 
of eligible families described in subsection 
(k)(2); and 
‘‘(C) the State’s capacity for providing 
substance abuse treatment and counseling serv-
ices to individuals and families in need of such 
treatment or services. 
‘‘(2) COORDINATION
WITH
OTHER
ASSESS-
MENTS.—In conducting the statewide needs assess-
ment required under paragraph (1), the State shall 
coordinate with, and take into account, other appro-
priate needs assessments conducted by the State, as 
determined by the Secretary, including the needs as-
sessment required under section 505(a) (both the 
most recently completed assessment and any such 
assessment in progress), the communitywide stra-
tegic planning and needs assessments conducted in 
accordance with section 640(g)(1)(C) of the Head 
Start Act, and the inventory of current unmet needs 
and current community-based and prevention-fo-
cused programs and activities to prevent child abuse 
and neglect, and other family resource services oper-
ating in the State required under section 205(3) of 
the Child Abuse Prevention and Treatment Act. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00570
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
571 
•AMDT. NO. 2786 
‘‘(3) SUBMISSION TO THE SECRETARY.—Each 
State shall submit to the Secretary, in such form 
and manner as the Secretary shall require— 
‘‘(A) the results of the statewide needs as-
sessment required under paragraph (1); and 
‘‘(B) a description of how the State in-
tends to address needs identified by the assess-
ment, particularly with respect to communities 
identified under paragraph (1)(A), which may 
include applying for a grant to conduct an early 
childhood home visitation program in accord-
ance with the requirements of this section. 
‘‘(c) GRANTS FOR EARLY CHILDHOOD HOME VISITA-
TION PROGRAMS.— 
‘‘(1) AUTHORITY TO MAKE GRANTS.—In addi-
tion to any other payments made under this title to 
a State, the Secretary shall make grants to eligible 
entities to enable the entities to deliver services 
under early childhood home visitation programs that 
satisfy the requirements of subsection (d) to eligible 
families in order to promote improvements in mater-
nal and prenatal health, infant health, child health 
and development, parenting related to child develop-
ment outcomes, school readiness, and the socio-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00571
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
572 
•AMDT. NO. 2786 
economic status of such families, and reductions in 
child abuse, neglect, and injuries. 
‘‘(2) AUTHORITY TO USE INITIAL GRANT FUNDS 
FOR PLANNING OR IMPLEMENTATION.—An eligible 
entity that receives a grant under paragraph (1) 
may use a portion of the funds made available to the 
entity during the first 6 months of the period for 
which the grant is made for planning or implementa-
tion activities to assist with the establishment of 
early childhood home visitation programs that sat-
isfy the requirements of subsection (d). 
‘‘(3) GRANT DURATION.—The Secretary shall 
determine the period of years for which a grant is 
made to an eligible entity under paragraph (1). 
‘‘(4) TECHNICAL ASSISTANCE.—The Secretary 
shall provide an eligible entity that receives a grant 
under paragraph (1) with technical assistance in ad-
ministering programs or activities conducted in 
whole or in part with grant funds. 
‘‘(d) REQUIREMENTS.—The requirements of this sub-
section for an early childhood home visitation program 
conducted with a grant made under this section are as 
follows: 
‘‘(1) QUANTIFIABLE, MEASURABLE
IMPROVE-
MENT IN BENCHMARK AREAS.— 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00572
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
573 
•AMDT. NO. 2786 
‘‘(A) IN GENERAL.—The eligible entity es-
tablishes, subject to the approval of the Sec-
retary, quantifiable, measurable 3- and 5-year 
benchmarks for demonstrating that the pro-
gram results in improvements for the eligible 
families participating in the program in each of 
the following areas: 
‘‘(i) Improved maternal and newborn 
health. 
‘‘(ii) Prevention of child injuries, child 
abuse, neglect, or maltreatment, and re-
duction of emergency department visits. 
‘‘(iii) Improvement in school readiness 
and achievement. 
‘‘(iv) Reduction in crime or domestic 
violence. 
‘‘(v) Improvements in family economic 
self-sufficiency. 
‘‘(vi) Improvements in the coordina-
tion and referrals for other community re-
sources and supports. 
‘‘(B) DEMONSTRATION OF IMPROVEMENTS 
AFTER 3 YEARS.— 
‘‘(i) REPORT TO THE SECRETARY.— 
Not later than 30 days after the end of the 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00573
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
574 
•AMDT. NO. 2786 
3rd year in which the eligible entity con-
ducts the program, the entity submits to 
the Secretary a report demonstrating im-
provement in at least 4 of the areas speci-
fied in subparagraph (A). 
‘‘(ii) CORRECTIVE ACTION PLAN.—If 
the report submitted by the eligible entity 
under clause (i) fails to demonstrate im-
provement in at least 4 of the areas speci-
fied in subparagraph (A), the entity shall 
develop and implement a plan to improve 
outcomes in each of the areas specified in 
subparagraph (A), subject to approval by 
the Secretary. The plan shall include provi-
sions for the Secretary to monitor imple-
mentation of the plan and conduct contin-
ued oversight of the program, including 
through submission by the entity of reg-
ular reports to the Secretary. 
‘‘(iii) TECHNICAL ASSISTANCE.— 
‘‘(I) IN
GENERAL.—The Sec-
retary shall provide an eligible entity 
required to develop and implement an 
improvement plan under clause (ii) 
with technical assistance to develop 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00574
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
575 
•AMDT. NO. 2786 
and implement the plan. The Sec-
retary may provide the technical as-
sistance directly or through grants, 
contracts, or cooperative agreements. 
‘‘(II) 
ADVISORY
PANEL.—The 
Secretary shall establish an advisory 
panel for purposes of obtaining rec-
ommendations regarding the technical 
assistance provided to entities in ac-
cordance with subclause (I). 
‘‘(iv) NO IMPROVEMENT OR FAILURE 
TO SUBMIT REPORT.—If the Secretary de-
termines after a period of time specified by 
the Secretary that an eligible entity imple-
menting an improvement plan under clause 
(ii) has failed to demonstrate any improve-
ment in the areas specified in subpara-
graph (A), or if the Secretary determines 
that an eligible entity has failed to submit 
the report required under clause (i), the 
Secretary shall terminate the entity’s grant 
and may include any unexpended grant 
funds in grants made to nonprofit organi-
zations under subsection (h)(2)(B). 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00575
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
576 
•AMDT. NO. 2786 
‘‘(C) FINAL REPORT.—Not later than De-
cember 31, 2015, the eligible entity shall sub-
mit a report to the Secretary demonstrating im-
provements (if any) in each of the areas speci-
fied in subparagraph (A). 
‘‘(2) IMPROVEMENTS IN OUTCOMES FOR INDI-
VIDUAL FAMILIES.— 
‘‘(A) IN GENERAL.—The program is de-
signed, with respect to an eligible family partici-
pating in the program, to result in the partici-
pant outcomes described in subparagraph (B) 
that the eligible entity identifies on the basis of 
an individualized assessment of the family, are 
relevant for that family. 
‘‘(B) PARTICIPANT OUTCOMES.—The par-
ticipant outcomes described in this subpara-
graph are the following: 
‘‘(i) Improvements in prenatal, mater-
nal, and newborn health, including im-
proved pregnancy outcomes 
‘‘(ii) Improvements in child health 
and development, including the prevention 
of child injuries and maltreatment and im-
provements in cognitive, language, social- 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00576
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
577 
•AMDT. NO. 2786 
emotional, and physical developmental indi-
cators. 
‘‘(iii) 
Improvements 
in 
parenting 
skills. 
‘‘(iv) Improvements in school readi-
ness and child academic achievement. 
‘‘(v) Reductions in crime or domestic 
violence. 
‘‘(vi) Improvements in family eco-
nomic self-sufficiency. 
‘‘(vii) Improvements in the coordina-
tion of referrals for, and the provision of, 
other community resources and supports 
for eligible families, consistent with State 
child welfare agency training. 
‘‘(3) CORE
COMPONENTS.—The program in-
cludes the following core components: 
‘‘(A) SERVICE DELIVERY MODEL OR MOD-
ELS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the program is conducted using 1 or 
more of the service delivery models de-
scribed in item (aa) or (bb) of subclause 
(I) or in subclause (II) selected by the eli-
gible entity: 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00577
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
578 
•AMDT. NO. 2786 
‘‘(I) The model conforms to a 
clear consistent home visitation model 
that has been in existence for at least 
3 years and is research-based, ground-
ed 
in 
relevant 
empirically-based 
knowledge, linked to program deter-
mined outcomes, associated with a na-
tional organization or institution of 
higher education that has comprehen-
sive home visitation program stand-
ards that ensure high quality service 
delivery and continuous program qual-
ity 
improvement, 
and 
has 
dem-
onstrated significant, (and in the case 
of the service delivery model described 
in item (aa), sustained) positive out-
comes, as described in the benchmark 
areas specified in paragraph (1)(A) 
and the participant outcomes de-
scribed in paragraph (2)(B), when 
evaluated using well-designed and rig-
orous— 
‘‘(aa) randomized controlled 
research designs, and the evalua-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00578
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
579 
•AMDT. NO. 2786 
tion results have been published 
in a peer-reviewed journal; or 
‘‘(bb) quasi-experimental re-
search designs. 
‘‘(II) The model conforms to a 
promising 
and 
new 
approach 
to 
achieving the benchmark areas speci-
fied in paragraph (1)(A) and the par-
ticipant outcomes described in para-
graph (2)(B), has been developed or 
identified by a national organization 
or institution of higher education, and 
will be evaluated through well-de-
signed and rigorous process. 
‘‘(ii) MAJORITY
OF
GRANT
FUNDS 
USED FOR EVIDENCE-BASED MODELS.—An 
eligible entity shall use not more than 25 
percent of the amount of the grant paid to 
the entity for a fiscal year for purposes of 
conducting a program using the service de-
livery model described in clause (i)(II). 
‘‘(iii) CRITERIA FOR EVIDENCE OF EF-
FECTIVENESS OF MODELS.—The Secretary 
shall establish criteria for evidence of effec-
tiveness of the service delivery models and 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00579
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
580 
•AMDT. NO. 2786 
shall ensure that the process for estab-
lishing the criteria is transparent and pro-
vides the opportunity for public comment. 
‘‘(B) ADDITIONAL REQUIREMENTS.— 
‘‘(i) The program adheres to a clear, 
consistent model that satisfies the require-
ments of being grounded in empirically- 
based knowledge related to home visiting 
and linked to the benchmark areas speci-
fied in paragraph (1)(A) and the partici-
pant outcomes described in paragraph 
(2)(B) related to the purposes of the pro-
gram. 
‘‘(ii) The program employs well- 
trained and competent staff, as dem-
onstrated by education or training, such as 
nurses, social workers, educators, child de-
velopment specialists, or other well-trained 
and competent staff, and provides ongoing 
and specific training on the model being 
delivered. 
‘‘(iii) The program maintains high 
quality supervision to establish home vis-
itor competencies. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00580
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
581 
•AMDT. NO. 2786 
‘‘(iv) 
The 
program 
demonstrates 
strong organizational capacity to imple-
ment the activities involved. 
‘‘(v) The program establishes appro-
priate linkages and referral networks to 
other community resources and supports 
for eligible families. 
‘‘(vi) The program monitors the fidel-
ity of program implementation to ensure 
that services are delivered pursuant to the 
specified model. 
‘‘(4) PRIORITY FOR SERVING HIGH-RISK POPU-
LATIONS.—The eligible entity gives priority to pro-
viding services under the program to the following: 
‘‘(A) Eligible families who reside in com-
munities in need of such services, as identified 
in the statewide needs assessment required 
under subsection (b)(1)(A). 
‘‘(B) Low-income eligible families. 
‘‘(C) Eligible families who are pregnant 
women who have not attained age 21. 
‘‘(D) Eligible families that have a history 
of child abuse or neglect or have had inter-
actions with child welfare services. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00581
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
582 
•AMDT. NO. 2786 
‘‘(E) Eligible families that have a history 
of substance abuse or need substance abuse 
treatment. 
‘‘(F) Eligible families that have users of 
tobacco products in the home. 
‘‘(G) Eligible families that are or have chil-
dren with low student achievement. 
‘‘(H) Eligible families with children with 
developmental delays or disabilities. 
‘‘(I) Eligible families who, or that include 
individuals who, are serving or formerly served 
in the Armed Forces, including such families 
that have members of the Armed Forces who 
have had multiple deployments outside of the 
United States. 
‘‘(e) APPLICATION REQUIREMENTS.—An eligible en-
tity desiring a grant under this section shall submit an 
application to the Secretary for approval, in such manner 
as the Secretary may require, that includes the following: 
‘‘(1) A description of the populations to be 
served by the entity, including specific information 
regarding how the entity will serve high risk popu-
lations described in subsection (d)(4). 
‘‘(2) An assurance that the entity will give pri-
ority to serving low-income eligible families and eligi-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00582
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
583 
•AMDT. NO. 2786 
ble families who reside in at risk communities identi-
fied in the statewide needs assessment required 
under subsection (b)(1)(A). 
‘‘(3) The service delivery model or models de-
scribed in subsection (d)(3)(A) that the entity will 
use under the program and the basis for the selec-
tion of the model or models. 
‘‘(4) A statement identifying how the selection 
of the populations to be served and the service deliv-
ery model or models that the entity will use under 
the program for such populations is consistent with 
the results of the statewide needs assessment con-
ducted under subsection (b). 
‘‘(5) The quantifiable, measurable benchmarks 
established by the State to demonstrate that the 
program contributes to improvements in the areas 
specified in subsection (d)(1)(A). 
‘‘(6) An assurance that the entity will obtain 
and submit documentation or other appropriate evi-
dence from the organization or entity that developed 
the service delivery model or models used under the 
program to verify that the program is implemented 
and services are delivered according to the model 
specifications. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00583
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
584 
•AMDT. NO. 2786 
‘‘(7) Assurances that the entity will establish 
procedures to ensure that— 
‘‘(A) the participation of each eligible fam-
ily in the program is voluntary; and 
‘‘(B) services are provided to an eligible 
family in accordance with the individual assess-
ment for that family. 
‘‘(8) Assurances that the entity will— 
‘‘(A) submit annual reports to the Sec-
retary regarding the program and activities car-
ried out under the program that include such 
information and data as the Secretary shall re-
quire; and 
‘‘(B) participate in, and cooperate with, 
data and information collection necessary for 
the evaluation required under subsection (g)(2) 
and other research and evaluation activities car-
ried out under subsection (h)(3). 
‘‘(9) A description of other State programs that 
include home visitation services, including, if appli-
cable to the State, other programs carried out under 
this title with funds made available from allotments 
under section 502(c), programs funded under title 
IV, title II of the Child Abuse Prevention and Treat-
ment Act (relating to community-based grants for 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00584
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
585 
•AMDT. NO. 2786 
the prevention of child abuse and neglect), and sec-
tion 645A of the Head Start Act (relating to Early 
Head Start programs). 
‘‘(10) Other information as required by the Sec-
retary. 
‘‘(f) MAINTENANCE OF EFFORT.—Funds provided to 
an eligible entity receiving a grant under this section shall 
supplement, and not supplant, funds from other sources 
for early childhood home visitation programs or initiatives. 
‘‘(g) EVALUATION.— 
‘‘(1) 
INDEPENDENT, 
EXPERT
ADVISORY 
PANEL.—The Secretary, in accordance with sub-
section (h)(1)(A), shall appoint an independent advi-
sory panel consisting of experts in program evalua-
tion and research, education, and early childhood de-
velopment— 
‘‘(A) to review, and make recommendations 
on, the design and plan for the evaluation re-
quired under paragraph (2) within 1 year after 
the date of enactment of this section; 
‘‘(B) to maintain and advise the Secretary 
regarding the progress of the evaluation; and 
‘‘(C) to comment, if the panel so desires, 
on the report submitted under paragraph (3). 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00585
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
586 
•AMDT. NO. 2786 
‘‘(2) AUTHORITY TO CONDUCT EVALUATION.— 
On the basis of the recommendations of the advisory 
panel under paragraph (1), the Secretary shall, by 
grant, contract, or interagency agreement, conduct 
an evaluation of the statewide needs assessments 
submitted under subsection (b) and the grants made 
under subsections (c) and (h)(3)(B). The evaluation 
shall include— 
‘‘(A) an analysis, on a State-by-State 
basis, of the results of such assessments, in-
cluding indicators of maternal and prenatal 
health and infant health and mortality, and 
State actions in response to the assessments; 
and 
‘‘(B) an assessment of— 
‘‘(i) the effect of early childhood home 
visitation programs on child and parent 
outcomes, including with respect to each of 
the benchmark areas specified in sub-
section (d)(1)(A) and the participant out-
comes described in subsection (d)(2)(B); 
‘‘(ii) the effectiveness of such pro-
grams on different populations, including 
the extent to which the ability of programs 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00586
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
587 
•AMDT. NO. 2786 
to improve participant outcomes varies 
across programs and populations; and 
‘‘(iii) the potential for the activities 
conducted under such programs, if scaled 
broadly, to improve health care practices, 
eliminate health disparities, and improve 
health care system quality, efficiencies, and 
reduce costs. 
‘‘(3) REPORT.—Not later than March 31, 2015, 
the Secretary shall submit a report to Congress on 
the results of the evaluation conducted under para-
graph (2) and shall make the report publicly avail-
able. 
‘‘(h) OTHER PROVISIONS.— 
‘‘(1) 
INTRA-AGENCY
COLLABORATION.—The 
Secretary shall ensure that the Maternal and Child 
Health Bureau and the Administration for Children 
and Families collaborate with respect to carrying out 
this section, including with respect to— 
‘‘(A) reviewing and analyzing the statewide 
needs assessments required under subsection 
(b), the awarding and oversight of grants 
awarded under this section, the establishment 
of the advisory panels required under sub-
sections (d)(1)(B)(iii)(II) and (g)(1), and the 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00587
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
588 
•AMDT. NO. 2786 
evaluation and report required under subsection 
(g); and 
‘‘(B) consulting with other Federal agen-
cies with responsibility for administering or 
evaluating programs that serve eligible families 
to coordinate and collaborate with respect to re-
search related to such programs and families, 
including the Office of the Assistant Secretary 
for Planning and Evaluation of the Department 
of Health and Human Services, the Centers for 
Disease Control and Prevention, the National 
Institute of Child Health and Human Develop-
ment of the National Institutes of Health, the 
Office of Juvenile Justice and Delinquency Pre-
vention of the Department of Justice, and the 
Institute of Education Sciences of the Depart-
ment of Education. 
‘‘(2) GRANTS TO ELIGIBLE ENTITIES THAT ARE 
NOT STATES.— 
‘‘(A) INDIAN TRIBES, TRIBAL ORGANIZA-
TIONS, OR
URBAN
INDIAN
ORGANIZATIONS.— 
The Secretary shall specify requirements for eli-
gible entities that are Indian Tribes (or a con-
sortium of Indian Tribes), Tribal Organiza-
tions, or Urban Indian Organizations to apply 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00588
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
589 
•AMDT. NO. 2786 
for and conduct an early childhood home visita-
tion program with a grant under this section. 
Such requirements shall, to the greatest extent 
practicable, be consistent with the requirements 
applicable to eligible entities that are States 
and shall require an Indian Tribe (or consor-
tium), Tribal Organization, or Urban Indian 
Organization to— 
‘‘(i) conduct a needs assessment simi-
lar to the assessment required for all 
States under subsection (b); and 
‘‘(ii) establish quantifiable, measur-
able 3- and 5-year benchmarks consistent 
with subsection (d)(1)(A). 
‘‘(B) NONPROFIT ORGANIZATIONS.—If, as 
of the beginning of fiscal year 2012, a State 
has not applied or been approved for a grant 
under this section, the Secretary may use 
amounts appropriated under paragraph (1) of 
subsection (j) that are available for expenditure 
under paragraph (3) of that subsection to make 
a grant to an eligible entity that is a nonprofit 
organization described in subsection (k)(1)(B) 
to conduct an early childhood home visitation 
program in the State. The Secretary shall speci-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00589
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
590 
•AMDT. NO. 2786 
fy the requirements for such an organization to 
apply for and conduct the program which shall, 
to the greatest extent practicable, be consistent 
with the requirements applicable to eligible enti-
ties that are States and shall require the orga-
nization to— 
‘‘(i) carry out the program based on 
the needs assessment conducted by the 
State under subsection (b); and 
‘‘(ii) establish quantifiable, measur-
able 3- and 5-year benchmarks consistent 
with subsection (d)(1)(A). 
‘‘(3) RESEARCH AND OTHER EVALUATION AC-
TIVITIES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
carry out a continuous program of research and 
evaluation activities in order to increase knowl-
edge about the implementation and effective-
ness of home visiting programs, using random 
assignment designs to the maximum extent fea-
sible. The Secretary may carry out such activi-
ties directly, or through grants, cooperative 
agreements, or contracts. 
‘‘(B) 
REQUIREMENTS.—The 
Secretary 
shall ensure that— 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00590
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
591 
•AMDT. NO. 2786 
‘‘(i) evaluation of a specific program 
or project is conducted by persons or indi-
viduals not directly involved in the oper-
ation of such program or project; and 
‘‘(ii) the conduct of research and eval-
uation activities includes consultation with 
independent researchers, State officials, 
and developers and providers of home vis-
iting programs on topics including research 
design and administrative data matching. 
‘‘(4) REPORT
AND
RECOMMENDATION.—Not 
later than December 31, 2015, the Secretary shall 
submit a report to Congress regarding the programs 
conducted with grants under this section. The report 
required under this paragraph shall include— 
‘‘(A) information regarding the extent to 
which eligible entities receiving grants under 
this section demonstrated improvements in each 
of the areas specified in subsection (d)(1)(A); 
‘‘(B) information regarding any technical 
assistance 
provided 
under 
subsection 
(d)(1)(B)(iii)(I), including the type of any such 
assistance provided; and 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00591
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
592 
•AMDT. NO. 2786 
‘‘(C) recommendations for such legislative 
or administrative action as the Secretary deter-
mines appropriate. 
‘‘(i) APPLICATION
OF
OTHER
PROVISIONS
OF 
TITLE.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the other provisions of this title shall not 
apply to a grant made under this section. 
‘‘(2) EXCEPTIONS.—The following provisions of 
this title shall apply to a grant made under this sec-
tion to the same extent and in the same manner as 
such provisions apply to allotments made under sec-
tion 502(c): 
‘‘(A) Section 504(b)(6) (relating to prohi-
bition on payments to excluded individuals and 
entities). 
‘‘(B) Section 504(c) (relating to the use of 
funds for the purchase of technical assistance). 
‘‘(C) Section 504(d) (relating to a limita-
tion on administrative expenditures). 
‘‘(D) Section 506 (relating to reports and 
audits), but only to the extent determined by 
the Secretary to be appropriate for grants made 
under this section. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00592
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
593 
•AMDT. NO. 2786 
‘‘(E) Section 507 (relating to penalties for 
false statements). 
‘‘(F) 
Section 
508 
(relating 
to 
non-
discrimination). 
‘‘(G) Section 509(a) (relating to the ad-
ministration of the grant program). 
‘‘(j) APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there are ap-
propriated to the Secretary to carry out this sec-
tion— 
‘‘(A) $100,000,000 for fiscal year 2010; 
‘‘(B) $250,000,000 for fiscal year 2011; 
‘‘(C) $350,000,000 for fiscal year 2012; 
‘‘(D) $400,000,000 for fiscal year 2013; 
and 
‘‘(E) $400,000,000 for fiscal year 2014. 
‘‘(2) RESERVATIONS.—Of the amount appro-
priated under this subsection for a fiscal year, the 
Secretary shall reserve— 
‘‘(A) 3 percent of such amount for pur-
poses of making grants to eligible entities that 
are Indian Tribes (or a consortium of Indian 
Tribes), Tribal Organizations, or Urban Indian 
Organizations; and 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00593
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
594 
•AMDT. NO. 2786 
‘‘(B) 3 percent of such amount for pur-
poses of carrying out subsections (d)(1)(B)(iii), 
(g), and (h)(3). 
‘‘(3) AVAILABILITY.—Funds made available to 
an eligible entity under this section for a fiscal year 
shall remain available for expenditure by the eligible 
entity through the end of the second succeeding fis-
cal year after award. Any funds that are not ex-
pended by the eligible entity during the period in 
which the funds are available under the preceding 
sentence may be used for grants to nonprofit organi-
zations under subsection (h)(2)(B). 
‘‘(k) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.— 
‘‘(A) IN GENERAL.—The term ‘eligible en-
tity’ means a State, an Indian Tribe, Tribal Or-
ganization, or Urban Indian Organization, 
Puerto Rico, Guam, the Virgin Islands, the 
Northern Mariana Islands, and American 
Samoa. 
‘‘(B) NONPROFIT
ORGANIZATIONS.—Only 
for purposes of awarding grants under sub-
section (h)(2)(B), such term shall include a 
nonprofit organization with an established 
record of providing early childhood home visita-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00594
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
595 
•AMDT. NO. 2786 
tion programs or initiatives in a State or sev-
eral States. 
‘‘(2) ELIGIBLE
FAMILY.—The term ‘eligible 
family’ means— 
‘‘(A) a woman who is pregnant, and the fa-
ther of the child if the father is available; or 
‘‘(B) a parent or primary caregiver of a 
child, including grandparents or other relatives 
of the child, and foster parents, who are serving 
as the child’s primary caregiver from birth to 
kindergarten entry, and including a noncusto-
dial parent who has an ongoing relationship 
with, and at times provides physical care for, 
the child. 
‘‘(3) INDIAN TRIBE; TRIBAL ORGANIZATION.— 
The terms ‘Indian Tribe’ and ‘Tribal Organization’, 
and ‘Urban Indian Organization’ have the meanings 
given such terms in section 4 of the Indian Health 
Care Improvement Act.’’. 
SEC. 2952. SUPPORT, EDUCATION, AND RESEARCH FOR 
POSTPARTUM DEPRESSION. 
(a) RESEARCH ON POSTPARTUM CONDITIONS.— 
(1) EXPANSION AND INTENSIFICATION OF AC-
TIVITIES.—The Secretary of Health and Human 
Services (in this subsection and subsection (c) re-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00595
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
596 
•AMDT. NO. 2786 
ferred to as the ‘‘Secretary’’) is encouraged to con-
tinue 
activities 
on 
postpartum 
depression 
or 
postpartum psychosis (in this subsection and sub-
section (c) referred to as ‘‘postpartum conditions’’), 
including research to expand the understanding of 
the causes of, and treatments for, postpartum condi-
tions. Activities under this paragraph shall include 
conducting and supporting the following: 
(A) Basic research concerning the etiology 
and causes of the conditions. 
(B) Epidemiological studies to address the 
frequency and natural history of the conditions 
and the differences among racial and ethnic 
groups with respect to the conditions. 
(C) The development of improved screen-
ing and diagnostic techniques. 
(D) Clinical research for the development 
and evaluation of new treatments. 
(E) Information and education programs 
for health care professionals and the public, 
which may include a coordinated national cam-
paign to increase the awareness and knowledge 
of postpartum conditions. Activities under such 
a national campaign may— 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00596
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
597 
•AMDT. NO. 2786 
(i) include public service announce-
ments through television, radio, and other 
means; and 
(ii) focus on— 
(I) 
raising 
awareness 
about 
screening; 
(II) educating new mothers and 
their families about postpartum condi-
tions to promote earlier diagnosis and 
treatment; and 
(III) ensuring that such edu-
cation includes complete information 
concerning postpartum conditions, in-
cluding its symptoms, methods of cop-
ing with the illness, and treatment re-
sources. 
(2) SENSE OF CONGRESS REGARDING LONGITU-
DINAL STUDY OF RELATIVE MENTAL HEALTH CON-
SEQUENCES FOR WOMEN OF RESOLVING A PREG-
NANCY.— 
(A) SENSE OF CONGRESS.—It is the sense 
of Congress that the Director of the National 
Institute of Mental Health may conduct a na-
tionally representative longitudinal study (dur-
ing the period of fiscal years 2010 through 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00597
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
598 
•AMDT. NO. 2786 
2019) of the relative mental health con-
sequences for women of resolving a pregnancy 
(intended and unintended) in various ways, in-
cluding carrying the pregnancy to term and 
parenting the child, carrying the pregnancy to 
term and placing the child for adoption, mis-
carriage, and having an abortion. This study 
may assess the incidence, timing, magnitude, 
and duration of the immediate and long-term 
mental health consequences (positive or nega-
tive) of these pregnancy outcomes. 
(B) REPORT.—Subject to the completion 
of the study under subsection (a), beginning not 
later than 5 years after the date of the enact-
ment of this Act, and periodically thereafter for 
the duration of the study, such Director may 
prepare and submit to the Congress reports on 
the findings of the study. 
(b) GRANTS TO PROVIDE SERVICES TO INDIVIDUALS 
WITH
A POSTPARTUM CONDITION
AND THEIR FAMI-
LIES.—Title V of the Social Security Act (42 U.S.C. 701 
et seq.), as amended by section 2951, is amended by add-
ing at the end the following new section: 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00598
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
599 
•AMDT. NO. 2786 
‘‘SEC. 
512. 
SERVICES 
TO 
INDIVIDUALS 
WITH 
A 
POSTPARTUM CONDITION AND THEIR FAMI-
LIES. 
‘‘(a) IN GENERAL.—In addition to any other pay-
ments made under this title to a State, the Secretary may 
make grants to eligible entities for projects for the estab-
lishment, operation, and coordination of effective and cost- 
efficient systems for the delivery of essential services to 
individuals with or at risk for postpartum conditions and 
their families. 
‘‘(b) CERTAIN ACTIVITIES.—To the extent prac-
ticable and appropriate, the Secretary shall ensure that 
projects funded under subsection (a) provide education 
and services with respect to the diagnosis and manage-
ment of postpartum conditions for individuals with or at 
risk for postpartum conditions and their families. The Sec-
retary may allow such projects to include the following: 
‘‘(1) Delivering or enhancing outpatient and 
home-based health and support services, including 
case management and comprehensive treatment 
services. 
‘‘(2) Delivering or enhancing inpatient care 
management services that ensure the well-being of 
the mother and family and the future development 
of the infant. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00599
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
600 
•AMDT. NO. 2786 
‘‘(3) Improving the quality, availability, and or-
ganization of health care and support services (in-
cluding transportation services, attendant care, 
homemaker services, day or respite care, and pro-
viding counseling on financial assistance and insur-
ance). 
‘‘(4) Providing education about postpartum 
conditions to promote earlier diagnosis and treat-
ment. Such education may include— 
‘‘(A) providing complete information on 
postpartum conditions, symptoms, methods of 
coping with the illness, and treatment re-
sources; and 
‘‘(B) in the case of a grantee that is a 
State, hospital, or birthing facility— 
‘‘(i) providing education to new moth-
ers and fathers, and other family members 
as appropriate, concerning postpartum 
conditions before new mothers leave the 
health facility; and 
‘‘(ii) ensuring that training programs 
regarding such education are carried out 
at the health facility. 
‘‘(c) INTEGRATION WITH OTHER PROGRAMS.—To 
the extent practicable and appropriate, the Secretary may 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00600
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
601 
•AMDT. NO. 2786 
integrate the grant program under this section with other 
grant programs carried out by the Secretary, including the 
program under section 330 of the Public Health Service 
Act. 
‘‘(d) REQUIREMENTS.—The Secretary shall establish 
requirements for grants made under this section that in-
clude a limit on the amount of grants funds that may be 
used for administration, accounting, reporting, or program 
oversight functions and a requirement for each eligible en-
tity that receives a grant to submit, for each grant period, 
a report to the Secretary that describes how grant funds 
were used during such period. 
‘‘(e) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to entities seeking a grant 
under this section in order to assist such entities in com-
plying with the requirements of this section. 
‘‘(f) APPLICATION
OF
OTHER
PROVISIONS
OF 
TITLE.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the other provisions of this title shall not 
apply to a grant made under this section. 
‘‘(2) EXCEPTIONS.—The following provisions of 
this title shall apply to a grant made under this sec-
tion to the same extent and in the same manner as 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00601
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
602 
•AMDT. NO. 2786 
such provisions apply to allotments made under sec-
tion 502(c): 
‘‘(A) Section 504(b)(6) (relating to prohi-
bition on payments to excluded individuals and 
entities). 
‘‘(B) Section 504(c) (relating to the use of 
funds for the purchase of technical assistance). 
‘‘(C) Section 504(d) (relating to a limita-
tion on administrative expenditures). 
‘‘(D) Section 506 (relating to reports and 
audits), but only to the extent determined by 
the Secretary to be appropriate for grants made 
under this section. 
‘‘(E) Section 507 (relating to penalties for 
false statements). 
‘‘(F) 
Section 
508 
(relating 
to 
non-
discrimination). 
‘‘(G) Section 509(a) (relating to the ad-
ministration of the grant program). 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) The term ‘eligible entity’— 
‘‘(A) means a public or nonprofit private 
entity; and 
‘‘(B) includes a State or local government, 
public-private partnership, recipient of a grant 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00602
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
603 
•AMDT. NO. 2786 
under section 330H of the Public Health Serv-
ice Act (relating to the Healthy Start Initia-
tive), public or nonprofit private hospital, com-
munity-based organization, hospice, ambulatory 
care facility, community health center, migrant 
health center, public housing primary care cen-
ter, or homeless health center. 
‘‘(2) The term ‘postpartum condition’ means 
postpartum depression or postpartum psychosis.’’. 
(c) GENERAL PROVISIONS.— 
(1) AUTHORIZATION OF APPROPRIATIONS.—To 
carry out this section and the amendment made by 
subsection (b), there are authorized to be appro-
priated, in addition to such other sums as may be 
available for such purpose— 
(A) $3,000,000 for fiscal year 2010; and 
(B) such sums as may be necessary for fis-
cal years 2011 and 2012. 
(2) REPORT BY THE SECRETARY.— 
(A) STUDY.—The Secretary shall conduct 
a study on the benefits of screening for 
postpartum conditions. 
(B) REPORT.—Not later than 2 years after 
the date of the enactment of this Act, the Sec-
retary shall complete the study required by sub-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00603
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
604 
•AMDT. NO. 2786 
paragraph (A) and submit a report to the Con-
gress on the results of such study. 
SEC. 2953. PERSONAL RESPONSIBILITY EDUCATION. 
Title V of the Social Security Act (42 U.S.C. 701 
et seq.), as amended by sections 2951 and 2952(c), is 
amended by adding at the end the following: 
‘‘SEC. 513. PERSONAL RESPONSIBILITY EDUCATION. 
‘‘(a) ALLOTMENTS TO STATES.— 
‘‘(1) AMOUNT.— 
‘‘(A) IN GENERAL.—For the purpose de-
scribed in subsection (b), subject to the suc-
ceeding provisions of this section, for each of 
fiscal years 2010 through 2014, the Secretary 
shall allot to each State an amount equal to the 
product of— 
‘‘(i) the amount appropriated under 
subsection (f) for the fiscal year and avail-
able for allotments to States after the ap-
plication of subsection (c); and 
‘‘(ii) the State youth population per-
centage determined under paragraph (2). 
‘‘(B) MINIMUM ALLOTMENT.— 
‘‘(i) IN GENERAL.—Each State allot-
ment under this paragraph for a fiscal 
year shall be at least $250,000. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00604
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
605 
•AMDT. NO. 2786 
‘‘(ii) PRO RATA ADJUSTMENTS.—The 
Secretary shall adjust on a pro rata basis 
the amount of the State allotments deter-
mined under this paragraph for a fiscal 
year to the extent necessary to comply with 
clause (i). 
‘‘(C) APPLICATION REQUIRED TO ACCESS 
ALLOTMENTS.— 
‘‘(i) IN GENERAL.—A State shall not 
be paid from its allotment for a fiscal year 
unless the State submits an application to 
the Secretary for the fiscal year and the 
Secretary approves the application (or re-
quires changes to the application that the 
State satisfies) and meets such additional 
requirements as the Secretary may specify. 
‘‘(ii) REQUIREMENTS.—The State ap-
plication shall contain an assurance that 
the State has complied with the require-
ments of this section in preparing and sub-
mitting the application and shall include 
the following as well as such additional in-
formation as the Secretary may require: 
‘‘(I) Based on data from the 
Centers for Disease Control and Pre-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00605
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
606 
•AMDT. NO. 2786 
vention National Center for Health 
Statistics, the most recent pregnancy 
rates for the State for youth ages 10 
to 14 and youth ages 15 to 19 for 
which data are available, the most re-
cent birth rates for such youth popu-
lations in the State for which data are 
available, and trends in those rates 
for the most recently preceding 5-year 
period for which such data are avail-
able. 
‘‘(II) State-established goals for 
reducing the pregnancy rates and 
birth rates for such youth populations. 
‘‘(III) 
A 
description 
of 
the 
State’s plan for using the State allot-
ments provided under this section to 
achieve such goals, especially among 
youth populations that are the most 
high-risk or vulnerable for pregnancies 
or 
otherwise 
have 
special 
cir-
cumstances, including youth in foster 
care, homeless youth, youth with HIV/ 
AIDS, pregnant youth who are under 
21 years of age, mothers who are 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00606
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
607 
•AMDT. NO. 2786 
under 21 years of age, and youth re-
siding in areas with high birth rates 
for youth. 
‘‘(2) STATE
YOUTH
POPULATION
PERCENT-
AGE.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1)(A)(ii), the State youth population 
percentage is, with respect to a State, the pro-
portion (expressed as a percentage) of— 
‘‘(i) the number of individuals who 
have attained age 10 but not attained age 
20 in the State; to 
‘‘(ii) the number of such individuals in 
all States. 
‘‘(B) DETERMINATION
OF
NUMBER
OF 
YOUTH.—The number of individuals described 
in clauses (i) and (ii) of subparagraph (A) in a 
State shall be determined on the basis of the 
most recent Bureau of the Census data. 
‘‘(3) AVAILABILITY OF STATE ALLOTMENTS.— 
Subject to paragraph (4)(A), amounts allotted to a 
State pursuant to this subsection for a fiscal year 
shall remain available for expenditure by the State 
through the end of the second succeeding fiscal year. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00607
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
608 
•AMDT. NO. 2786 
‘‘(4) AUTHORITY
TO
AWARD
GRANTS
FROM 
STATE ALLOTMENTS TO LOCAL ORGANIZATIONS AND 
ENTITIES IN NONPARTICIPATING STATES.— 
‘‘(A) GRANTS FROM UNEXPENDED ALLOT-
MENTS.—If a State does not submit an applica-
tion under this section for fiscal year 2010 or 
2011, the State shall no longer be eligible to 
submit an application to receive funds from the 
amounts allotted for the State for each of fiscal 
years 2010 through 2014 and such amounts 
shall be used by the Secretary to award grants 
under this paragraph for each of fiscal years 
2012 through 2014. The Secretary also shall 
use any amounts from the allotments of States 
that submit applications under this section for 
a fiscal year that remain unexpended as of the 
end of the period in which the allotments are 
available for expenditure under paragraph (3) 
for awarding grants under this paragraph. 
‘‘(B) 3-YEAR GRANTS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall solicit applications to award 3-year 
grants in each of fiscal years 2012, 2013, 
and 2014 to local organizations and enti-
ties to conduct, consistent with subsection 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00608
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
609 
•AMDT. NO. 2786 
(b), programs and activities in States that 
do not submit an application for an allot-
ment under this section for fiscal year 
2010 or 2011. 
‘‘(ii) FAITH-BASED
ORGANIZATIONS 
OR CONSORTIA.—The Secretary may solicit 
and award grants under this paragraph to 
faith-based organizations or consortia. 
‘‘(C) EVALUATION.—An organization or 
entity awarded a grant under this paragraph 
shall agree to participate in a rigorous Federal 
evaluation. 
‘‘(5) MAINTENANCE OF EFFORT.—No payment 
shall be made to a State from the allotment deter-
mined for the State under this subsection or to a 
local organization or entity awarded a grant under 
paragraph (4), if the expenditure of non-federal 
funds by the State, organization, or entity for activi-
ties, programs, or initiatives for which amounts from 
allotments and grants under this subsection may be 
expended is less than the amount expended by the 
State, organization, or entity for such programs or 
initiatives for fiscal year 2009. 
‘‘(6) DATA COLLECTION AND REPORTING.—A 
State or local organization or entity receiving funds 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00609
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
610 
•AMDT. NO. 2786 
under this section shall cooperate with such require-
ments relating to the collection of data and informa-
tion and reporting on outcomes regarding the pro-
grams and activities carried out with such funds, as 
the Secretary shall specify. 
‘‘(b) PURPOSE.— 
‘‘(1) IN GENERAL.—The purpose of an allot-
ment under subsection (a)(1) to a State is to enable 
the State (or, in the case of grants made under sub-
section (a)(4)(B), to enable a local organization or 
entity) to carry out personal responsibility education 
programs consistent with this subsection. 
‘‘(2) PERSONAL
RESPONSIBILITY
EDUCATION 
PROGRAMS.— 
‘‘(A) IN
GENERAL.—In this section, the 
term ‘personal responsibility education pro-
gram’ means a program that is designed to 
educate adolescents on— 
‘‘(i) both abstinence and contraception 
for the prevention of pregnancy and sexu-
ally transmitted infections, including HIV/ 
AIDS, consistent with the requirements of 
subparagraph (B); and 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00610
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
611 
•AMDT. NO. 2786 
‘‘(ii) at least 3 of the adulthood prep-
aration subjects described in subparagraph 
(C). 
‘‘(B) REQUIREMENTS.—The requirements 
of this subparagraph are the following: 
‘‘(i) The program replicates evidence- 
based effective programs or substantially 
incorporates elements of effective programs 
that have been proven on the basis of rig-
orous scientific research to change behav-
ior, which means delaying sexual activity, 
increasing condom or contraceptive use for 
sexually active youth, or reducing preg-
nancy among youth. 
‘‘(ii) The program is medically-accu-
rate and complete. 
‘‘(iii) The program includes activities 
to educate youth who are sexually active 
regarding responsible sexual behavior with 
respect to both abstinence and the use of 
contraception. 
‘‘(iv) The program places substantial 
emphasis on both abstinence and contra-
ception for the prevention of pregnancy 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00611
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
612 
•AMDT. NO. 2786 
among youth and sexually transmitted in-
fections. 
‘‘(v) The program provides age-appro-
priate information and activities. 
‘‘(vi) The information and activities 
carried out under the program are pro-
vided in the cultural context that is most 
appropriate for individuals in the par-
ticular population group to which they are 
directed. 
‘‘(C) 
ADULTHOOD
PREPARATION
SUB-
JECTS.—The adulthood preparation subjects 
described in this subparagraph are the fol-
lowing: 
‘‘(i) Healthy relationships, such as 
positive self-esteem and relationship dy-
namics, friendships, dating, romantic in-
volvement, marriage, and family inter-
actions. 
‘‘(ii) Adolescent development, such as 
the development of healthy attitudes and 
values about adolescent growth and devel-
opment, body image, racial and ethnic di-
versity, and other related subjects. 
‘‘(iii) Financial literacy. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00612
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
613 
•AMDT. NO. 2786 
‘‘(iv) Parent-child communication. 
‘‘(v) Educational and career success, 
such as developing skills for employment 
preparation, job seeking, independent liv-
ing, financial self-sufficiency, and work-
place productivity. 
‘‘(vi) Healthy life skills, such as goal- 
setting, decision making, negotiation, com-
munication and interpersonal skills, and 
stress management. 
‘‘(c) RESERVATIONS OF FUNDS.— 
‘‘(1) GRANTS
TO
IMPLEMENT
INNOVATIVE 
STRATEGIES.—From the amount appropriated under 
subsection (f) for the fiscal year, the Secretary shall 
reserve $10,000,000 of such amount for purposes of 
awarding grants to entities to implement innovative 
youth pregnancy prevention strategies and target 
services to high-risk, vulnerable, and culturally 
under-represented 
youth 
populations, 
including 
youth in foster care, homeless youth, youth with 
HIV/AIDS, pregnant women who are under 21 years 
of age and their partners, mothers who are under 21 
years of age and their partners, and youth residing 
in areas with high birth rates for youth. An entity 
awarded a grant under this paragraph shall agree to 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00613
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
614 
•AMDT. NO. 2786 
participate in a rigorous Federal evaluation of the 
activities carried out with grant funds. 
‘‘(2) 
OTHER
RESERVATIONS.—From 
the 
amount appropriated under subsection (f) for the 
fiscal year that remains after the application of 
paragraph (1), the Secretary shall reserve the fol-
lowing amounts: 
‘‘(A) GRANTS
FOR
INDIAN
TRIBES
OR 
TRIBAL ORGANIZATIONS.—The Secretary shall 
reserve 5 percent of such remainder for pur-
poses of awarding grants to Indian tribes and 
tribal organizations in such manner, and sub-
ject to such requirements, as the Secretary, in 
consultation with Indian tribes and tribal orga-
nizations, determines appropriate. 
‘‘(B) SECRETARIAL RESPONSIBILITIES.— 
‘‘(i) RESERVATION
OF
FUNDS.—The 
Secretary shall reserve 10 percent of such 
remainder for expenditures by the Sec-
retary for the activities described in 
clauses (ii) and (iii). 
‘‘(ii) PROGRAM
SUPPORT.—The Sec-
retary shall provide, directly or through a 
competitive grant process, research, train-
ing and technical assistance, including dis-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00614
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
615 
•AMDT. NO. 2786 
semination of research and information re-
garding effective and promising practices, 
providing consultation and resources on a 
broad array of teen pregnancy prevention 
strategies, including abstinence and contra-
ception, and developing resources and ma-
terials to support the activities of recipi-
ents of grants and other State, tribal, and 
community organizations working to re-
duce teen pregnancy. In carrying out such 
functions, the Secretary shall collaborate 
with a variety of entities that have exper-
tise in the prevention of teen pregnancy, 
HIV and sexually transmitted infections, 
healthy relationships, financial literacy, 
and other topics addressed through the 
personal responsibility education programs. 
‘‘(iii) EVALUATION.—The Secretary 
shall evaluate the programs and activities 
carried out with funds made available 
through allotments or grants under this 
section. 
‘‘(d) ADMINISTRATION.— 
‘‘(1) IN GENERAL.—The Secretary shall admin-
ister this section through the Assistant Secretary for 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00615
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
616 
•AMDT. NO. 2786 
the Administration for Children and Families within 
the Department of Health and Human Services. 
‘‘(2) APPLICATION OF OTHER PROVISIONS OF 
TITLE.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the other provisions of this 
title shall not apply to allotments or grants 
made under this section. 
‘‘(B) EXCEPTIONS.—The following provi-
sions of this title shall apply to allotments and 
grants made under this section to the same ex-
tent and in the same manner as such provisions 
apply to allotments made under section 502(c): 
‘‘(i) Section 504(b)(6) (relating to 
prohibition on payments to excluded indi-
viduals and entities). 
‘‘(ii) Section 504(c) (relating to the 
use of funds for the purchase of technical 
assistance). 
‘‘(iii) Section 504(d) (relating to a 
limitation on administrative expenditures). 
‘‘(iv) Section 506 (relating to reports 
and audits), but only to the extent deter-
mined by the Secretary to be appropriate 
for grants made under this section. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00616
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
617 
•AMDT. NO. 2786 
‘‘(v) Section 507 (relating to penalties 
for false statements). 
‘‘(vi) Section 508 (relating to non-
discrimination). 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) AGE-APPROPRIATE.—The term ‘age-appro-
priate’, with respect to the information in pregnancy 
prevention, means topics, messages, and teaching 
methods suitable to particular ages or age groups of 
children and adolescents, based on developing cog-
nitive, emotional, and behavioral capacity typical for 
the age or age group. 
‘‘(2) MEDICALLY ACCURATE AND COMPLETE.— 
The term ‘medically accurate and complete’ means 
verified or supported by the weight of research con-
ducted in compliance with accepted scientific meth-
ods and— 
‘‘(A) published in peer-reviewed journals, 
where applicable; or 
‘‘(B) comprising information that leading 
professional organizations and agencies with 
relevant expertise in the field recognize as accu-
rate, objective, and complete. 
‘‘(3) 
INDIAN
TRIBES; 
TRIBAL
ORGANIZA-
TIONS.—The terms ‘Indian tribe’ and ‘Tribal organi-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00617
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
618 
•AMDT. NO. 2786 
zation’ have the meanings given such terms in sec-
tion 4 of the Indian Health Care Improvement Act 
(25 U.S.C. 1603)). 
‘‘(4) YOUTH.—The term ‘youth’ means an indi-
vidual who has attained age 10 but has not attained 
age 20. 
‘‘(f) APPROPRIATION.—For the purpose of carrying 
out this section, there is appropriated, out of any money 
in the Treasury not otherwise appropriated, $75,000,000 
for each of fiscal years 2010 through 2014. Amounts ap-
propriated under this subsection shall remain available 
until expended.’’. 
SEC. 2954. RESTORATION OF FUNDING FOR ABSTINENCE 
EDUCATION. 
Section 510 of the Social Security Act (42 U.S.C. 
710) is amended— 
(1) in subsection (a), by striking ‘‘fiscal year 
1998 and each subsequent fiscal year’’ and inserting 
‘‘each of fiscal years 2010 through 2014’’; and 
(2) in subsection (d)— 
(A) in the first sentence, by striking ‘‘1998 
through 2003’’ and inserting ‘‘2010 through 
2014’’; and 
(B) in the second sentence, by inserting 
‘‘(except that such appropriation shall be made 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00618
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
619 
•AMDT. NO. 2786 
on the date of enactment of the Patient Protec-
tion and Affordable Care Act in the case of fis-
cal year 2010)’’ before the period. 
SEC. 2955. INCLUSION OF INFORMATION ABOUT THE IM-
PORTANCE OF HAVING A HEALTH CARE 
POWER OF ATTORNEY IN TRANSITION PLAN-
NING FOR CHILDREN AGING OUT OF FOSTER 
CARE AND INDEPENDENT LIVING PROGRAMS. 
(a) TRANSITION PLANNING.—Section 475(5)(H) of 
the Social Security Act (42 U.S.C. 675(5)(H)) is amended 
by inserting ‘‘includes information about the importance 
of designating another individual to make health care 
treatment decisions on behalf of the child if the child be-
comes unable to participate in such decisions and the child 
does not have, or does not want, a relative who would oth-
erwise be authorized under State law to make such deci-
sions, and provides the child with the option to execute 
a health care power of attorney, health care proxy, or 
other similar document recognized under State law,’’ after 
‘‘employment services,’’. 
(b) INDEPENDENT
LIVING
EDUCATION.—Section 
477(b)(3) of such Act (42 U.S.C. 677(b)(3)) is amended 
by adding at the end the following: 
‘‘(K) A certification by the chief executive 
officer of the State that the State will ensure 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00619
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
620 
•AMDT. NO. 2786 
that an adolescent participating in the program 
under this section are provided with education 
about the importance of designating another in-
dividual to make health care treatment deci-
sions on behalf of the adolescent if the adoles-
cent becomes unable to participate in such deci-
sions and the adolescent does not have, or does 
not want, a relative who would otherwise be au-
thorized under State law to make such deci-
sions, whether a health care power of attorney, 
health care proxy, or other similar document is 
recognized under State law, and how to execute 
such a document if the adolescent wants to do 
so.’’. 
(c) 
HEALTH
OVERSIGHT
AND
COORDINATION 
PLAN.—Section 422(b)(15)(A) of such Act (42 U.S.C. 
622(b)(15)(A)) is amended— 
(1) in clause (v), by striking ‘‘and’’ at the end; 
and 
(2) by adding at the end the following: 
‘‘(vii) steps to ensure that the compo-
nents of the transition plan development 
process required under section 475(5)(H) 
that relate to the health care needs of chil-
dren aging out of foster care, including the 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00620
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
621 
•AMDT. NO. 2786 
requirements to include options for health 
insurance, information about a health care 
power of attorney, health care proxy, or 
other similar document recognized under 
State law, and to provide the child with the 
option to execute such a document, are 
met; and’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2010. 
TITLE 
III—IMPROVING 
THE 
QUALITY AND EFFICIENCY OF 
HEALTH CARE 
Subtitle A—Transforming the 
Health Care Delivery System 
PART I—LINKING PAYMENT TO QUALITY 
OUTCOMES UNDER THE MEDICARE PROGRAM 
SEC. 3001. HOSPITAL VALUE-BASED PURCHASING PRO-
GRAM. 
(a) PROGRAM.— 
(1) IN GENERAL.—Section 1886 of the Social 
Security Act (42 U.S.C. 1395ww), as amended by 
section 4102(a) of the HITECH Act (Public Law 
111–5), is amended by adding at the end the fol-
lowing new subsection: 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00621
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
622 
•AMDT. NO. 2786 
‘‘(o) HOSPITAL VALUE-BASED PURCHASING PRO-
GRAM.— 
‘‘(1) ESTABLISHMENT.— 
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding provisions of this subsection, the Sec-
retary shall establish a hospital value-based 
purchasing program (in this subsection referred 
to as the ‘Program’) under which value-based 
incentive payments are made in a fiscal year to 
hospitals that meet the performance standards 
under paragraph (3) for the performance period 
for such fiscal year (as established under para-
graph (4)). 
‘‘(B) PROGRAM TO BEGIN IN FISCAL YEAR 
2013.—The Program shall apply to payments 
for discharges occurring on or after October 1, 
2012. 
‘‘(C) APPLICABILITY OF PROGRAM TO HOS-
PITALS.— 
‘‘(i) IN
GENERAL.—For purposes of 
this subsection, subject to clause (ii), the 
term ‘hospital’ means a subsection (d) hos-
pital (as defined in subsection (d)(1)(B)). 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00622
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
623 
•AMDT. NO. 2786 
‘‘(ii) EXCLUSIONS.—The term ‘hos-
pital’ shall not include, with respect to a 
fiscal year, a hospital— 
‘‘(I) that is subject to the pay-
ment 
reduction 
under 
subsection 
(b)(3)(B)(viii)(I) for such fiscal year; 
‘‘(II) for which, during the per-
formance period for such fiscal year, 
the Secretary has cited deficiencies 
that pose immediate jeopardy to the 
health or safety of patients; 
‘‘(III) for which there are not a 
minimum number (as determined by 
the Secretary) of measures that apply 
to the hospital for the performance 
period for such fiscal year; or 
‘‘(IV) for which there are not a 
minimum number (as determined by 
the Secretary) of cases for the meas-
ures that apply to the hospital for the 
performance period for such fiscal 
year. 
‘‘(iii) INDEPENDENT ANALYSIS.—For 
purposes of determining the minimum 
numbers under subclauses (III) and (IV) 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00623
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
624 
•AMDT. NO. 2786 
of clause (ii), the Secretary shall have con-
ducted an independent analysis of what 
numbers are appropriate. 
‘‘(iv) EXEMPTION.—In the case of a 
hospital 
that 
is 
paid 
under 
section 
1814(b)(3), the Secretary may exempt 
such hospital from the application of this 
subsection if the State which is paid under 
such section submits an annual report to 
the Secretary describing how a similar pro-
gram in the State for a participating hos-
pital or hospitals achieves or surpasses the 
measured results in terms of patient health 
outcomes and cost savings established 
under this subsection. 
‘‘(2) MEASURES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
select measures for purposes of the Program. 
Such measures shall be selected from the meas-
ures specified under subsection (b)(3)(B)(viii). 
‘‘(B) REQUIREMENTS.— 
‘‘(i) FOR
FISCAL
YEAR
2013.—For 
value-based incentive payments made with 
respect to discharges occurring during fis-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00624
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
625 
•AMDT. NO. 2786 
cal year 2013, the Secretary shall ensure 
the following: 
‘‘(I) CONDITIONS
OR
PROCE-
DURES.—Measures are selected under 
subparagraph (A) that cover at least 
the following 5 specific conditions or 
procedures: 
‘‘(aa) Acute myocardial in-
farction (AMI). 
‘‘(bb) Heart failure. 
‘‘(cc) Pneumonia. 
‘‘(dd) Surgeries, as meas-
ured by the Surgical Care Im-
provement Project (formerly re-
ferred to as ‘Surgical Infection 
Prevention’ for discharges occur-
ring before July 2006). 
‘‘(ee) Healthcare-associated 
infections, as measured by the 
prevention metrics and targets 
established in the HHS Action 
Plan to Prevent Healthcare-Asso-
ciated Infections (or any suc-
cessor plan) of the Department 
of Health and Human Services. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00625
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
626 
•AMDT. NO. 2786 
‘‘(II) HCAHPS.—Measures se-
lected under subparagraph (A) shall 
be related to the Hospital Consumer 
Assessment of Healthcare Providers 
and Systems survey (HCAHPS). 
‘‘(ii) 
INCLUSION
OF
EFFICIENCY 
MEASURES.—For 
value-based 
incentive 
payments made with respect to discharges 
occurring during fiscal year 2014 or a sub-
sequent fiscal year, the Secretary shall en-
sure that measures selected under subpara-
graph (A) include efficiency measures, in-
cluding measures of ‘Medicare spending 
per beneficiary’. Such measures shall be 
adjusted for factors such as age, sex, race, 
severity of illness, and other factors that 
the Secretary determines appropriate. 
‘‘(C) LIMITATIONS.— 
‘‘(i) TIME REQUIREMENT FOR PRIOR 
REPORTING AND NOTICE.—The Secretary 
may not select a measure under subpara-
graph (A) for use under the Program with 
respect to a performance period for a fiscal 
year (as established under paragraph (4)) 
unless such measure has been specified 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00626
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
627 
•AMDT. NO. 2786 
under subsection (b)(3)(B)(viii) and in-
cluded on the Hospital Compare Internet 
website for at least 1 year prior to the be-
ginning of such performance period. 
‘‘(ii) MEASURE NOT APPLICABLE UN-
LESS HOSPITAL FURNISHES SERVICES AP-
PROPRIATE TO THE MEASURE.—A measure 
selected under subparagraph (A) shall not 
apply to a hospital if such hospital does 
not furnish services appropriate to such 
measure. 
‘‘(D) REPLACING
MEASURES.—Subclause 
(VI) of subsection (b)(3)(B)(viii) shall apply to 
measures selected under subparagraph (A) in 
the same manner as such subclause applies to 
measures selected under such subsection. 
‘‘(3) PERFORMANCE STANDARDS.— 
‘‘(A) 
ESTABLISHMENT.—The 
Secretary 
shall establish performance standards with re-
spect to measures selected under paragraph (2) 
for a performance period for a fiscal year (as 
established under paragraph (4)). 
‘‘(B) 
ACHIEVEMENT
AND
IMPROVE-
MENT.—The performance standards established 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00627
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
628 
•AMDT. NO. 2786 
under subparagraph (A) shall include levels of 
achievement and improvement. 
‘‘(C) TIMING.—The Secretary shall estab-
lish and announce the performance standards 
under subparagraph (A) not later than 60 days 
prior to the beginning of the performance pe-
riod for the fiscal year involved. 
‘‘(D) CONSIDERATIONS IN ESTABLISHING 
STANDARDS.—In 
establishing 
performance 
standards with respect to measures under this 
paragraph, the Secretary shall take into ac-
count appropriate factors, such as— 
‘‘(i) practical experience with the 
measures involved, including whether a sig-
nificant proportion of hospitals failed to 
meet the performance standard during pre-
vious performance periods; 
‘‘(ii) historical performance standards; 
‘‘(iii) improvement rates; and 
‘‘(iv) the opportunity for continued 
improvement. 
‘‘(4) PERFORMANCE PERIOD.—For purposes of 
the Program, the Secretary shall establish the per-
formance period for a fiscal year. Such performance 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00628
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
629 
•AMDT. NO. 2786 
period shall begin and end prior to the beginning of 
such fiscal year. 
‘‘(5) HOSPITAL PERFORMANCE SCORE.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary shall develop a meth-
odology for assessing the total performance of 
each hospital based on performance standards 
with respect to the measures selected under 
paragraph (2) for a performance period (as es-
tablished under paragraph (4)). Using such 
methodology, the Secretary shall provide for an 
assessment (in this subsection referred to as the 
‘hospital performance score’) for each hospital 
for each performance period. 
‘‘(B) APPLICATION.— 
‘‘(i) APPROPRIATE
DISTRIBUTION.— 
The Secretary shall ensure that the appli-
cation of the methodology developed under 
subparagraph (A) results in an appropriate 
distribution of value-based incentive pay-
ments under paragraph (6) among hos-
pitals achieving different levels of hospital 
performance scores, with hospitals achiev-
ing the highest hospital performance scores 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00629
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
630 
•AMDT. NO. 2786 
receiving the largest value-based incentive 
payments. 
‘‘(ii) HIGHER
OF
ACHIEVEMENT
OR 
IMPROVEMENT.—The methodology devel-
oped under subparagraph (A) shall provide 
that the hospital performance score is de-
termined using the higher of its achieve-
ment or improvement score for each meas-
ure. 
‘‘(iii) WEIGHTS.—The methodology 
developed under subparagraph (A) shall 
provide for the assignment of weights for 
categories of measures as the Secretary de-
termines appropriate. 
‘‘(iv) NO
MINIMUM
PERFORMANCE 
STANDARD.—The Secretary shall not set a 
minimum performance standard in deter-
mining the hospital performance score for 
any hospital. 
‘‘(v) REFLECTION OF MEASURES AP-
PLICABLE
TO
THE
HOSPITAL.—The hos-
pital performance score for a hospital shall 
reflect the measures that apply to the hos-
pital. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00630
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
631 
•AMDT. NO. 2786 
‘‘(6) CALCULATION
OF
VALUE-BASED
INCEN-
TIVE PAYMENTS.— 
‘‘(A) IN GENERAL.—In the case of a hos-
pital that the Secretary determines meets (or 
exceeds) the performance standards under para-
graph (3) for the performance period for a fis-
cal year (as established under paragraph (4)), 
the Secretary shall increase the base operating 
DRG payment amount (as defined in paragraph 
(7)(D)), as determined after application of 
paragraph (7)(B)(i), for a hospital for each dis-
charge occurring in such fiscal year by the 
value-based incentive payment amount. 
‘‘(B) VALUE-BASED INCENTIVE PAYMENT 
AMOUNT.—The value-based incentive payment 
amount for each discharge of a hospital in a fis-
cal year shall be equal to the product of— 
‘‘(i) the base operating DRG payment 
amount (as defined in paragraph (7)(D)) 
for the discharge for the hospital for such 
fiscal year; and 
‘‘(ii) the value-based incentive pay-
ment percentage specified under subpara-
graph (C) for the hospital for such fiscal 
year. 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00631
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
687 
•AMDT. NO. 2786 
‘‘(B) the evaluation of quality of care 
under paragraph (2), including the establish-
ment of appropriate measures of the quality of 
care under paragraph (2)(B); 
‘‘(C) the evaluation of costs under para-
graph (3), including the establishment of appro-
priate measures of costs under such paragraph; 
‘‘(D) the dates for implementation of the 
value-based payment modifier; 
‘‘(E) the specification of the initial per-
formance period and any other performance pe-
riod under paragraphs (4)(B)(ii) and (8)(B), 
respectively; 
‘‘(F) the application of the value-based 
payment modifier under paragraph (7); and 
‘‘(G) the determination of costs under 
paragraph (8)(A).’’. 
SEC. 3008. PAYMENT ADJUSTMENT FOR CONDITIONS AC-
QUIRED IN HOSPITALS. 
(a) IN GENERAL.—Section 1886 of the Social Secu-
rity Act (42 U.S.C. 1395ww), as amended by section 
3001, is amended by adding at the end the following new 
subsection: 
‘‘(p) ADJUSTMENT
TO HOSPITAL PAYMENTS
FOR 
HOSPITAL ACQUIRED CONDITIONS.— 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00687
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
821 
•AMDT. NO. 2786 
(2) Subsection (f)(1) of section 410A of the 
Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108–173; 
117 Stat. 2272) is amended— 
(A) in subparagraph (A)(ii), by striking 
‘‘paragraph (2)’’ and inserting ‘‘subparagraph 
(B)’’; and 
(B) in subparagraph (B), by striking 
‘‘paragraph (1)(B)’’ and inserting ‘‘subpara-
graph (A)(ii)’’. 
SEC. 3124. EXTENSION OF THE MEDICARE-DEPENDENT 
HOSPITAL (MDH) PROGRAM. 
(a) EXTENSION OF PAYMENT METHODOLOGY.—Sec-
tion 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(G)) is amended— 
(1) in clause (i), by striking ‘‘October 1, 2011’’ 
and inserting ‘‘October 1, 2012’’; and 
(2) in clause (ii)(II), by striking ‘‘October 1, 
2011’’ and inserting ‘‘October 1, 2012’’. 
(b) CONFORMING AMENDMENTS.— 
(1) EXTENSION OF TARGET AMOUNT.—Section 
1886(b)(3)(D) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(D)) is amended— 
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00821
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
854 
•AMDT. NO. 2786 
‘‘(III) CHANGE
IN
PRESUMED 
UTILIZATION LEVEL OF CERTAIN AD-
VANCED DIAGNOSTIC IMAGING SERV-
ICES FOR 2010 THROUGH 2012.—Effec-
tive for fee schedules established be-
ginning with 2010 and ending with 
2012, reduced expenditures attrib-
utable to the presumed rate of utiliza-
tion of imaging equipment of 65 per-
cent under subsection (b)(4)(C)(i) in-
stead of a presumed rate of utilization 
of such equipment of 50 percent. 
‘‘(IV) CHANGE
IN
PRESUMED 
UTILIZATION LEVEL OF CERTAIN AD-
VANCED DIAGNOSTIC IMAGING SERV-
ICES
FOR
2013.—Effective for fee 
schedules established for 2013, re-
duced expenditures attributable to the 
presumed rate of utilization of imag-
ing equipment of 70 percent under 
subsection (b)(4)(C)(ii) instead of a 
presumed rate of utilization of such 
equipment of 50 percent. 
‘‘(V) CHANGE IN PRESUMED UTI-
LIZATION
LEVEL
OF
CERTAIN
AD-
VerDate Nov 24 2008 
00:00 Nov 20, 2009
Jkt 089200
PO 00000
Frm 00854
Fmt 6654
Sfmt 6201
E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS