I 
111TH CONGRESS 
1ST SESSION H. R. 3158 
To reform health care delivery by providing incentives for place-based health 
care, which seeks to bring health services to the patient by locating 
community health centers, federally qualified health centers, and commu-
nity integrated health centers in or near settings that already serve 
a particular target population, such as schools, workplaces, and senior 
services facilities. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 9, 2009 
Mr. SARBANES introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means and Education and Labor, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To reform health care delivery by providing incentives for 
place-based health care, which seeks to bring health serv-
ices to the patient by locating community health centers, 
federally qualified health centers, and community inte-
grated health centers in or near settings that already 
serve a particular target population, such as schools, 
workplaces, and senior services facilities. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Place Based Health Care Act of 2009’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—COMMUNITY INTEGRATED HEALTH CENTERS 
Sec. 101. Definitions. 
Sec. 102. Funding benefits. 
TITLE II—SCHOOL-BASED HEALTH CENTERS 
Sec. 201. Assurance of payment under Medicaid and CHIP for covered items 
and services furnished by certain school-based health clinics. 
TITLE III—TAX CREDIT FOR EMPLOYER-PROVIDED HEALTH AND 
WELLNESS BENEFITS 
Sec. 301. Credit for employer-provided health and wellness benefits. 
TITLE 
IV—EVIDENCE-BASED 
DISEASE 
PREVENTION 
AND 
HEALTH PROMOTION PROGRAM; SENIOR HOUSING FACILITY 
PLAN OPTION 
Sec. 301. Evidence-based disease prevention and health promotion grant pro-
gram. 
Sec. 302. Offering Medicare Advantage plan in a senior housing facility. 
TITLE V—COMMUNITY HEALTH CENTER EXPANSION OF 
PRIORITIES 
Sec. 401. Community health center expansion. 
TITLE I—COMMUNITY 
INTEGRATED HEALTH CENTERS 
SEC. 101. DEFINITIONS. 
In this Act: 
(1) COMMUNITY
INTEGRATED
HEALTH
CEN-
TER.—The term ‘‘Community Integrated Health 
Center’’ means an organization that— 
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(A) seeks to fully integrate its services into 
the community by locating in or near settings 
that serve particular target populations, such as 
schools, workplaces, or senior service facilities; 
(B) is owned or controlled by, or comprised 
of, two or more institutional providers or 
groups of health care professionals that are eli-
gible for participation in part A or part B of 
Medicare; 
(C) is organized for the purpose of pro-
viding health care, improving the quality of 
health care, and reducing costs associated with 
the provision of health care provided to Center 
patients; 
(D) participates in Medicare and Medicaid; 
(E) requires all of its participating pro-
viders to participate in Medicare and Medicaid; 
(F) is not excluded or precluded from par-
ticipation in any Federal or State health care 
program; 
(G) is organized to receive payment from 
government and private health plans in a man-
ner that promotes cost reductions, including— 
(i) accepting global or bundled pay-
ments; and 
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(ii) accepting fixed-fee or capitated 
payments; 
(H) accepts all patients enrolled in Medi-
care and Medicaid; 
(I) does not discriminate on the basis of 
any prohibited criteria; 
(J) does not discriminate with respect to 
the provision of care to patients of the Center 
on the basis of the patient’s insurance status or 
ability to pay; 
(K) maintains an affiliation with an acute 
care hospital; 
(L) maintains an affiliation with health 
care providers as necessary to meet the needs 
of its enrollees; 
(M) maintains a qualified workforce; 
(N) has a qualified medical director; 
(O) coordinates inpatient and outpatient 
care for its enrollees, including coordination of 
wellness and prevention services and care for 
chronic disease; 
(P) offers wellness, prevention, and health- 
promotion services; 
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(Q) develops, and requires its participating 
providers to follow, guidelines, protocols, evi-
dence-based medicine, and clinical pathways; 
(R) utilizes electronic medical records by 
the deadline set forth in the amendments made 
by the American Recovery and Reinvestment 
Act of 2009; 
(S) requires its participating providers to 
utilize electronic medical records by such dead-
lines; and 
(T) qualifies as an ‘‘organized health care 
arrangement’’ pursuant parts 160, 162, and 
164 of title 45, Code of Federal Regulations. 
(2) MEDICARE; MEDICAID.—The terms ‘‘Medi-
care’’ and ‘‘Medicaid’’ mean the programs under ti-
tles XVIII and XIX, respectively, of the Social Secu-
rity Act. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
SEC. 102. FUNDING BENEFITS. 
(a) LISTING.—A facility may obtain the benefits of 
this section by becoming listed as a Community Integrated 
Health Center by the Secretary. The Secretary shall list 
such a facility that— 
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(1) certifies to the Secretary that it meets the 
requirements for a Community Integrated Health 
Center under section 101(1); and 
(2) every three years demonstrates to the satis-
faction of the Secretary that the facility continues to 
meet such requirements. 
(b) COMMUNITY INTEGRATED HEALTH CENTER AS-
SISTANCE.— 
(1) 
ELIGIBLE
COMMUNITY
INTEGRATED 
HEALTH CENTER DEFINED.—In this subsection, the 
term ‘‘Eligible Community Integrated Health Cen-
ter’’ means an Community Integrated Health Center 
that has been listed under subsection (a). 
(2) GRANT PROGRAM.— 
(A) IN GENERAL.—The Secretary shall use 
such sums as may be necessary to carry out a 
program of grants to assist Eligible Community 
Integrated Health Centers with start-up and 
operating costs. 
(B) 
ADMINISTRATION.—The 
Secretary 
shall make grants to Eligible Community Inte-
grated Health Centers under this subsection on 
a competitive basis, to such Centers that dem-
onstrate to the satisfaction of the Secretary 
that the Center will— 
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(i) use the funds to— 
(I) promote the integration of 
health care providers; 
(II) promote coordination of pa-
tient care; 
(III) provide greater access to 
health care by patients within the 
Center’s geographic service area; 
(IV) locate services in or near a 
setting that serves their target popu-
lation, such as schools, workplaces, or 
senior services facilities; 
(V) reduce the cost of providing 
care; and 
(VI) improve the quality of care 
provided to patients within the Cen-
ter’s geographic service area; and 
(ii) not later than 12 months after the 
date on which the Secretary provides as-
sistance to the Center, submit to the Sec-
retary a report that describes— 
(I) the manner in which the as-
sistance was spent; 
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(II) the manner in which the fac-
tors outlined in clause (i) have been 
monitored; and 
(III) any measurable change in 
the factors outlined in such clause as 
a result of the Center’s receipt of as-
sistance. 
(C) TIMING.—Not later than 180 days 
after the date of enactment of this Act, the Sec-
retary shall make grants to provide assistance 
under this subsection. 
(3) REPORT TO CONGRESS.—Not later than 18 
months after the date of enactment of this Act, the 
Secretary shall submit to the appropriate committees 
of Congress a report that— 
(A) describes in detail the manner in which 
this grant program has been carried out; and 
(B) includes the information reported to 
the Secretary under paragraph (2)(B)(ii). 
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TITLE II—SCHOOL-BASED 
HEALTH CENTERS 
SEC. 201. ASSURANCE OF PAYMENT UNDER MEDICAID AND 
CHIP FOR COVERED ITEMS AND SERVICES 
FURNISHED 
BY 
CERTAIN 
SCHOOL-BASED 
HEALTH CLINICS. 
(a) STATE PLAN REQUIREMENT.—Section 1902(a) 
of the Social Security Act (42 U.S.C. 1396a(a)), as 
amended by section 5006(e)(2)(A) of division B of the 
American Recovery and Reinvestment Act of 2009 (Public 
Law 111–5), is amended— 
(1) in paragraph (72), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (73)(B), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (73), the fol-
lowing new paragraph: 
‘‘(74) provide that the State shall certify to the 
Secretary that the State has implemented proce-
dures to pay for medical assistance (including care 
and services described in subsections (a)(4)(B) and 
(r) of section 1905 and provided in accordance with 
section 1902(a)(43)) furnished in a school-based 
health clinic, if payment would be made under the 
State plan for the same items and services if fur-
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nished in a physician’s office or other outpatient 
clinic (including if such payment would be included 
in the determination of a prepaid capitation or other 
risk-based rate of payment to an entity under a con-
tract pursuant to section 1903(m)).’’. 
(b) SCHOOL-BASED HEALTH CLINIC DEFINED.— 
Section 1905 of such Act (42 U.S.C. 1396d) is amended 
by adding at the end the following new subsection: 
‘‘(y)(1) The term ‘school-based health clinic’ means 
a health clinic that— 
‘‘(A) is located in or near a school facility of a 
school district or board or of an Indian tribe or trib-
al organization; 
‘‘(B) is organized through school, community, 
and health provider relationships; 
‘‘(C) is administered by a sponsoring facility; 
‘‘(D) provides through health professionals pri-
mary health services to children in accordance with 
State and local law, including laws relating to licen-
sure and certification; and 
‘‘(E) satisfies such other requirements as a 
State may establish for the operation of such a clin-
ic. 
‘‘(2) For purposes of paragraph (1)(D), the term ‘pri-
mary health services’ means the core services offered by 
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a school-based health clinic, which shall include the fol-
lowing: 
‘‘(A) Comprehensive health assessments, diag-
nosis, and treatment of minor, acute, and chronic 
medical conditions and referrals to, and follow-up 
for, specialty care. 
‘‘(B) Mental health assessments, crisis interven-
tion, counseling, treatment, and referral to a con-
tinuum of services including emergency psychiatric 
care, community support programs, inpatient care, 
and outpatient programs. 
‘‘(C) Additional services, which may include 
oral health, social, and health education services. 
‘‘(3) For purposes of paragraph (1)(C), the term 
‘sponsoring facility’ is a community-based organization, 
which may include— 
‘‘(A) a hospital; 
‘‘(B) a public health department; 
‘‘(C) a community health center; 
‘‘(D) a nonprofit health care agency; 
‘‘(E) a school or school system; or 
‘‘(F) a program administered by the Indian 
Health Service or the Bureau of Indian Affairs or 
operated by an Indian tribe or a tribal organization 
under the Indian Self-Determination and Education 
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Assistance Act (25 U.S.C. 450), a Native Hawaiian 
entity, or an Urban Indian program under title V of 
the Indian Health Care Improvement Act (25 U.S.C. 
1601).’’. 
(c) APPLICATION TO CHIP.—Section 2107(e)(1) of 
the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended— 
(1) 
by 
redesignating 
subparagraphs 
(B) 
through (D) as subparagraphs (C) through (E), re-
spectively; and 
(2) by inserting after subparagraph (A), the fol-
lowing new subparagraph: 
‘‘(B) Section 1902(a)(74) (relating to pro-
cedures to ensure payment for covered services 
furnished in a school-based health clinic, as de-
fined in section 1905(y)).’’. 
(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion or the amendments made by this section shall be con-
strued to preempt or supersede State or local law with 
respect to whether a school-based health clinic provides 
family planning services and supplies. 
(e) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2009. 
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TITLE III—TAX CREDIT FOR EM-
PLOYER-PROVIDED 
HEALTH 
AND WELLNESS BENEFITS 
SEC. 301. CREDIT FOR EMPLOYER-PROVIDED HEALTH AND 
WELLNESS BENEFITS. 
(a) IN GENERAL.—Subpart D of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to business-related credits) is amended by 
adding at the end the following new section: 
‘‘SEC. 45R. CREDIT FOR EMPLOYER-PROVIDED HEALTH 
AND WELLNESS BENEFITS. 
‘‘(a) IN GENERAL.—For purposes of section 38, the 
employer-provided health and wellness benefits credit de-
termined under this section for the taxable year is an 
amount equal to 25 percent of the qualified health and 
wellness expenditures of the taxpayer for such taxable 
year. 
‘‘(b) DOLLAR LIMITATION.—The credit allowable 
under subsection (a) for any taxable year shall not exceed 
$150,000. 
‘‘(c) DEFINITIONS.—For purposes of this section— 
‘‘(1) QUALIFIED HEALTH AND WELLNESS EX-
PENDITURE.— 
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‘‘(A) IN
GENERAL.—The term ‘qualified 
health and wellness expenditure’ means any 
amount paid or incurred— 
‘‘(i) to acquire, construct, rehabilitate, 
or expand property— 
‘‘(I) which is to be used as part 
of a qualified health and wellness fa-
cility of the taxpayer, and 
‘‘(II) with respect to which a de-
duction for depreciation (or amortiza-
tion in lieu of depreciation) is allow-
able, 
‘‘(ii) for the operating costs of a quali-
fied health and wellness facility of the tax-
payer, or 
‘‘(iii) under a contract with a qualified 
health and wellness facility to provide 
health and wellness services to employees 
of the taxpayer. 
‘‘(B) FAIR
MARKET
VALUE.—The term 
‘qualified health and wellness expenditures’ 
shall not include expenses in excess of the fair 
market value of such care. 
‘‘(2) QUALIFIED HEALTH AND WELLNESS FA-
CILITY.— 
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‘‘(A) IN
GENERAL.—The term ‘qualified 
health and wellness facility’ means a facility— 
‘‘(i) the principal use of which is to 
provide medical care (including preventive 
care), and 
‘‘(ii) which meets the requirements of 
all applicable laws and regulations of the 
State or local government in which it is lo-
cated. 
‘‘(B) SPECIAL RULES WITH RESPECT TO A 
TAXPAYER.—A facility shall not be treated as a 
qualified health and wellness facility with re-
spect to a taxpayer unless— 
‘‘(i) enrollment in the facility is open 
to employees of the taxpayer during the 
taxable year, and 
‘‘(ii) the use of such facility (or the 
eligibility to use such facility) does not dis-
criminate in favor of employees of the tax-
payer who are highly compensated employ-
ees (within the meaning of section 414(q)). 
‘‘(d) RECAPTURE OF ACQUISITION AND CONSTRUC-
TION CREDIT.— 
‘‘(1) IN GENERAL.—If, as of the close of any 
taxable year, there is a recapture event with respect 
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to any qualified health and wellness facility of the 
taxpayer, then the tax of the taxpayer under this 
chapter for such taxable year shall be increased by 
an amount equal to the product of— 
‘‘(A) the applicable recapture percentage, 
and 
‘‘(B) the aggregate decrease in the credits 
allowed under section 38 for all prior taxable 
years which would have resulted if the qualified 
health and wellness expenditures of the tax-
payer described in subsection (c)(1)(A) with re-
spect to such facility had been zero. 
‘‘(2) APPLICABLE RECAPTURE PERCENTAGE.— 
‘‘(A) IN GENERAL.—For purposes of this 
subsection, the applicable recapture percentage 
shall be determined from the following table: 
‘‘If the recapture event occurs in: 
The applicable recapture 
percentage is: 
Years 1–3 .....................................................................................
100 
Year 4 ..........................................................................................
Year 5 ..........................................................................................
Year 6 ..........................................................................................
Year 7 ..........................................................................................
Year 8 ..........................................................................................
Years 9 and 10 ............................................................................
Years 11 and thereafter ...............................................................
0. 
‘‘(B) YEARS.—For purposes of subpara-
graph (A), year 1 shall begin on the first day 
of the taxable year in which the qualified health 
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and wellness facility is placed in service by the 
taxpayer. 
‘‘(3) RECAPTURE EVENT DEFINED.—For pur-
poses of this subsection, the term ‘recapture event’ 
means— 
‘‘(A) CESSATION
OF
OPERATION.—The 
cessation of the operation of the facility as a 
qualified health and wellness facility. 
‘‘(B) CHANGE IN OWNERSHIP.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), the disposition of a 
taxpayer’s interest in a qualified health 
and wellness facility with respect to which 
the credit described in subsection (a) was 
allowable. 
‘‘(ii) AGREEMENT TO ASSUME RECAP-
TURE
LIABILITY.—Clause (i) shall not 
apply if the person acquiring such interest 
in the facility agrees in writing to assume 
the recapture liability of the person dis-
posing of such interest in effect imme-
diately before such disposition. In the 
event of such an assumption, the person 
acquiring the interest in the facility shall 
be treated as the taxpayer for purposes of 
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assessing any recapture liability (computed 
as if there had been no change in owner-
ship). 
‘‘(4) SPECIAL RULES.— 
‘‘(A) TAX
BENEFIT
RULE.—The tax for 
the taxable year shall be increased under para-
graph (1) only with respect to credits allowed 
by reason of this section which were used to re-
duce tax liability. In the case of credits not so 
used to reduce tax liability, the carryforwards 
and carrybacks under section 39 shall be appro-
priately adjusted. 
‘‘(B) NO CREDITS AGAINST TAX.—Any in-
crease in tax under this subsection shall not be 
treated as a tax imposed by this chapter for 
purposes of determining the amount of any 
credit under this chapter or for purposes of sec-
tion 55. 
‘‘(C) NO RECAPTURE BY REASON OF CAS-
UALTY LOSS.—The increase in tax under this 
subsection shall not apply to a cessation of op-
eration of the facility as a qualified child care 
facility by reason of a casualty loss to the ex-
tent such loss is restored by reconstruction or 
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replacement within a reasonable period estab-
lished by the Secretary. 
‘‘(e) SPECIAL RULES.—For purposes of this sec-
tion— 
‘‘(1) AGGREGATION RULES.—All persons which 
are treated as a single employer under subsections 
(a) and (b) of section 52 shall be treated as a single 
taxpayer. 
‘‘(2) PASS-THRU IN THE CASE OF ESTATES AND 
TRUSTS.—Under regulations prescribed by the Sec-
retary, rules similar to the rules of subsection (d) of 
section 52 shall apply. 
‘‘(3) ALLOCATION IN THE CASE OF PARTNER-
SHIPS.—In the case of partnerships, the credit shall 
be allocated among partners under regulations pre-
scribed by the Secretary. 
‘‘(f) NO DOUBLE BENEFIT.— 
‘‘(1) REDUCTION IN BASIS.—For purposes of 
this subtitle— 
‘‘(A) IN GENERAL.—If a credit is deter-
mined under this section with respect to any 
property by reason of expenditures described in 
subsection (c)(1)(A), the basis of such property 
shall be reduced by the amount of the credit so 
determined. 
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‘‘(B) CERTAIN DISPOSITIONS.—If, during 
any taxable year, there is a recapture amount 
determined with respect to any property the 
basis of which was reduced under subparagraph 
(A), the basis of such property (immediately be-
fore the event resulting in such recapture) shall 
be increased by an amount equal to such recap-
ture amount. For purposes of the preceding 
sentence, the term ‘recapture amount’ means 
any 
increase 
in 
tax 
(or 
adjustment 
in 
carrybacks or carryovers) determined under 
subsection (d). 
‘‘(2) OTHER DEDUCTIONS AND CREDITS.—No 
deduction or credit shall be allowed under any other 
provision of this chapter with respect to the amount 
of the credit determined under this section.’’. 
(b) CREDIT TO BE PART OF GENERAL BUSINESS 
CREDIT.—Subsection (b) of section 38 of such Code (re-
lating to general business credit) is amended by striking 
‘‘plus’’ at the end of paragraph (34), by striking the period 
at the end of paragraph (35) and inserting ‘‘, plus’’ , and 
by adding at the end the following new paragraph: 
‘‘(36) 
the 
employer-provided 
health 
and 
wellness benefits credit determined under section 
45R(a).’’. 
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(c) CLERICAL AMENDMENT.—The table of sections 
for subpart D of part IV of subchapter A of chapter 1 
of such Code is amended by inserting after the item relat-
ing to section 45Q the following new item: 
‘‘Sec. 45R. Credit for employer-provided health and wellness benefits.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
TITLE IV—EVIDENCE-BASED DIS-
EASE 
PREVENTION 
AND 
HEALTH 
PROMOTION 
PRO-
GRAM; SENIOR HOUSING FA-
CILITY PLAN OPTION 
SEC. 301. EVIDENCE-BASED DISEASE PREVENTION AND 
HEALTH PROMOTION GRANT PROGRAM. 
Part D of title III of the Older Americans Act of 
1965 (42 U.S.C. 3030m et seq.) is amended— 
(1) by inserting the following before section 
361: 
‘‘Subpart 1—Services’’; and 
(2) by adding at the end the following: 
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‘‘Subpart 2—Evidence-based Disease Prevention and 
Health Promotion Program 
‘‘SEC. 365. EVIDENCE-BASED DISEASE PREVENTION AND 
HEALTH PROMOTION GRANTS PROGRAM. 
‘‘(a) GRANT PROGRAM.—From a portion of the funds 
allotted to carry out this part, the Assistant Secretary 
shall establish an evidence-based disease prevention and 
health promotion program to make grants to States to 
carry out— 
‘‘(1) evidence-based disease prevention pro-
grams; 
‘‘(2) evidence-based chronic disease manage-
ment programs; 
‘‘(3) evidence-based chronic disease self-man-
agement programs; 
‘‘(4) evidence-based health services and health 
promotion services and supports; 
‘‘(5) a disease self-management program such 
as the Stanford University Chronic Disease Self- 
Management Program (CDSMP). 
‘‘(b) APPLICATION FOR GRANT.—To request a grant 
under subsection (a), a State shall, after consulting and 
coordinating with area agencies on aging in the State in-
volved, submit an application to the Secretary at such 
time, in such manner, and containing the following infor-
mation: 
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‘‘(1) A description of the evidence-based disease 
prevention and health promotion programs the State 
agency proposes to carry out with such grant. 
‘‘(2) Sufficient information to demonstrate that 
the infrastructure exists to support the proposed 
programs. 
‘‘(3) Such other information as the Secretary 
determines appropriate. 
‘‘(c) SUBGRANTS.— 
‘‘(1) GRANTS TO AREA AGENCIES ON AGING.— 
With funds received under subsection (b), the State 
agency shall make grants to area agencies on aging 
that demonstrate performance capacity to carry out 
programs and activities described in subsection (a), 
to carry out evidence-based disease prevention and 
health promotion programs under this section either 
directly or through contracts with— 
‘‘(A) organizations that are providers of di-
rect services to older individuals and that re-
ceive funding under this Act; or 
‘‘(B) Federally Qualified Health Centers or 
Community Health Centers (as such terms are 
used in relation to section 330 of the Public 
Health Service Act) or Community Integrated 
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Health Centers (as defined in section 101 of 
the Place Based Health Care Act of 2009). 
‘‘(2) DIRECT GRANTS TO OTHER ENTITIES.—If 
an area agency on aging does not receive a grant 
under paragraph (1), the State agency may make a 
subgrant to carry out evidence-based disease preven-
tion and health promotion programs under this sec-
tion in the planning and service area of such agency, 
to— 
‘‘(A) organizations that are providers of di-
rect services to older individuals and that re-
ceive funding under this Act; or 
‘‘(B) Federally Qualified Health Centers or 
Community Health Centers (as such terms are 
used in relation to section 330 of the Public 
Health Service Act) or Community Integrated 
Health Centers (as defined in section 101 of 
the Place Based Health Care Act of 2009). 
that demonstrate performance capacity to carry out 
the programs and activities described in subsection 
(a). 
‘‘(d) USES OF FUNDS.—A grant or subgrant received 
under this section may be used to carry out— 
‘‘(1) an evidence-based chronic disease manage-
ment program; 
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‘‘(2) an evidence-based chronic disease self- 
management program; or 
‘‘(3) an evidence-based disease prevention and 
health promotion program. 
‘‘(e) DEFINITION.—In this section, the term ‘health 
services and health promotion services and supports’ 
means any service, any onsite primary care service, any 
in-home service, a case management service, or any evi-
dence-based intervention that is— 
‘‘(1) furnished in settings that serve the popu-
lation of older individuals such as— 
‘‘(A) a private home or residence; 
‘‘(B) a community based organization (as 
defined in section 1901 of the Elementary and 
Secondary Education Act of 1965 (20 U.S.C. 
7801)); 
‘‘(C) a Community Integrated Health Cen-
ter (as defined in section 101(1) of the Place 
Based Health Care Act of 2009); 
‘‘(D) a faith-based organization; 
‘‘(E) a community-care setting (including a 
small community care setting as defined in sub-
section (g)(1), and a large community care set-
ting as defined in subsection (h)(1), of section 
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1929 of the Social Security Act (42 U.S.C. 
1396t)); 
‘‘(F) a board and care facility; 
‘‘(G) a long-term care facility; 
‘‘(H) a multi-purpose senior center; or 
‘‘(I) a community center (as defined in sec-
tion 670G of the State Dependent Care Devel-
opment Grants Act (42 U.S.C. 9877)); 
‘‘(2) furnished to diagnose, treat, or cure a 
medical disease or condition; and 
‘‘(3) intended to assist older individuals with 
carrying out activities of daily living (as defined in 
section 802 of the Cranston-Gonzalez National Af-
fordable Housing Act (42 U.S.C. 8011).’’. 
SEC. 302. OFFERING MEDICARE ADVANTAGE PLAN IN A 
SENIOR HOUSING FACILITY. 
Section 1851(b)(1) of the Social Security Act (42 
U.S.C. 1395w–21(b)(1)) is amended by adding at the end 
the following new subparagraph: 
‘‘(D) SPECIAL RULE FOR SENIOR CITIZEN 
FACILITIES.—Notwithstanding any other provi-
sion of this part, a Medicare Advantage organi-
zation may operate a Medicare Advantage plan 
exclusively within a geographic area that is lim-
ited to a senior housing facility if the plan— 
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‘‘(i) provides services only to bene-
ficiaries who either— 
‘‘(I) are under a long-term resi-
dency contract as described in section 
1919(c)(5)(B)(v); or 
‘‘(II) reside in supportive housing 
for the elderly as described in section 
202 of the Housing Act of 1959 or 
housing supported by the low income 
housing tax credit program described 
in section 42 of the Internal Revenue 
Code of 1986, and qualify for assist-
ance under section 8 of the United 
States Housing Act of 1937; 
‘‘(ii) provides onsite primary care 
services with a ratio of accessible physi-
cians to beneficiaries that is deemed to be 
adequate by the Secretary; 
‘‘(iii) provides transportation services 
for patients to specialty providers outside 
the community; 
‘‘(iv) makes meaningful use of health 
information technology; and 
‘‘(v) if offered to continuing care re-
tirement or life care community residents 
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as described in clause (i)(I), has partici-
pated in a Centers for Medicare & Med-
icaid Services demonstration initiative for 
a minimum of one year.’’. 
TITLE V—COMMUNITY HEALTH 
CENTER EXPANSION OF PRI-
ORITIES 
SEC. 401. COMMUNITY HEALTH CENTER EXPANSION. 
Section 330 of the Public Health Service Act (42 
U.S.C. 254b) is amended by adding at the end the fol-
lowing new subsections: 
‘‘(s) SCHOOL-BASED HEALTH CENTERS.— 
‘‘(1) IN GENERAL.—The Secretary may award 
grants for the purposes described in subparagraphs 
(c), (e), and (f) of this section for the planning and 
delivery of services to a special medically under-
served population comprised of school-aged children 
in a school-based health center. 
‘‘(2) SCHOOL-BASED
HEALTH
CENTER
DE-
FINED.—In this section, the term ‘school-based 
health center’ means a health center that— 
‘‘(A) is located within an elementary or 
secondary school facility; 
‘‘(B) is operated in collaboration with the 
school in which such center is located; 
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‘‘(C) is administered by a community- 
based organization including a hospital, public 
health department, community health center, or 
nonprofit health care agency; 
‘‘(D) at a minimum, provides to school- 
aged children— 
‘‘(i) primary health care services, in-
cluding comprehensive health assessments, 
and diagnosis and treatment of minor, 
acute, and chronic medical conditions and 
Healthy Start benefits; 
‘‘(ii) mental health services, including 
crisis intervention, counseling, and emer-
gency psychiatric care at the school or by 
referral; 
‘‘(iii) the availability of services at the 
school when the school is open and 24-hour 
coverage through an on-call system with 
other providers to ensure access when the 
school or health center is closed; 
‘‘(iv) services through the use of a 
qualified and appropriately credentialed in-
dividual, including a nurse practitioner or 
physician assistant, a mental health profes-
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sional, a physician, and a health assistant; 
and 
‘‘(E) may provide optional preventive den-
tal services, consistent with State licensure law, 
through the use of dental hygienists or dental 
assistants that provide preventive services such 
as basic oral exams, cleanings, and sealants. 
‘‘(3) SUPPLEMENT
NOT
SUPPLANT.—A grant 
awarded under this subsection shall be expended to 
supplement, and not supplant, the expenditures of 
the health center and the value of in kind contribu-
tions for the delivery of services to the population 
described in paragraph (1). 
‘‘(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to carry out 
this subsection, in addition to any funds authorized 
to be appropriated or appropriated for health centers 
under any other subsection of this section, such 
sums as may be necessary for each of fiscal years 
2009 through 2014. 
‘‘(t) RESIDENTS OF NATURALLY OCCURRING RE-
TIREMENT
COMMUNITIES, RAPIDLY
AGING
COMMU-
NITIES, PATRONS
OF
MULTIPURPOSE
SENIOR
CEN-
TERS.— 
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‘‘(1) IN GENERAL.—The Secretary may award 
grants for the purposes described in subsections (c), 
(e), and (f) of this section for the planning and de-
livery of services to a special medically underserved 
population comprised of residents of Naturally Oc-
curring Retirement Communities and patrons of 
multipurpose senior centers and individuals living in 
areas and facilities immediately accessible to such 
Naturally Occurring Retirement Communities and 
such centers. 
‘‘(2) SUPPLEMENT
NOT
SUPPLANT.—A grant 
awarded under this subsection shall be expended to 
supplement, and not supplant, the expenditures of 
the health center and the value of in kind contribu-
tions for the delivery of services to the population 
described in paragraph (1). 
‘‘(3) CONSULTATION WITH AREA AGENCIES ON 
AGING.—The Secretary may not make a grant under 
paragraph (1) unless, with respect to the residents 
of Naturally Occurring Retirement Communities and 
patrons of multipurpose senior centers involved, the 
applicant for the grant— 
‘‘(A) has consulted with the Area Agency 
on Aging in the preparation of the application 
for the grant; and 
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‘‘(B) agrees to provide for ongoing con-
sultation with the Area Agency on Aging re-
garding the planning and administration of the 
program carried out with the grant. 
‘‘(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to carry out 
this subsection, in addition to any funds authorized 
to be appropriated or appropriated for health centers 
under any other subsection of this section, such 
sums as may be necessary for each of fiscal years 
2009 through 2014. 
‘‘(5) NATURALLY
OCCURRING
RETIREMENT 
COMMUNITY
AND
MULTIPURPOSE
SENIOR
CENTER 
DEFINED.—In this subsection, the terms ‘Naturally 
Occurring Retirement Community’ and ‘multipur-
pose senior center’ have the meanings given such 
terms for purposes of the Older Americans Act of 
1965 (42 U.S.C. 3001 et seq).’’. 
Æ 
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