2421 
carried out under the grant and the out-
comes of such activities. Such outcomes 
may include— 
(A) an increased number of in-
cumbent workers entering an accred-
ited school of nursing and in the pipe-
line for nursing programs; 
(B) an increasing number of grad-
uating nurses and improved nurse 
graduation and licensure rates; 
(C) improved nurse retention; 
(D) an increase in the number of 
staff nurses at the health care facility 
involved; 
(E) an increase in the number of 
nurses with advanced degrees in nurs-
ing; 
(F) an increase in the number of 
nurse faculty; 
(G) improved measures of patient 
quality (which may include staffing 
ratios of nurses, patient satisfaction 
rates, patient safety measures); and 
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(H) an increase in the diversity of 
new nurse graduates relative to the 
patient population. 
(2) GENERAL REPORT.—Not later than 2 
years after the date of the enactment of 
this Act, and annually thereafter, the Sec-
retary of Labor shall, using data and in-
formation from the reports received under 
paragraph (1), submit to the Congress a 
report concerning the overall effectiveness 
of the grant program carried out under 
this section. 
(i) AUTHORIZATION
OF APPROPRIATIONS.— 
There are authorized to be appropriated to 
carry out this section such sums as may be nec-
essary. 
ƒFor subtitle E of title V of division C, see 
text of bill as introduced on July 14, 2009.≈ 
Subtitle F—Standards for Accessi-
bility to Medical Equipment for 
Individuals With Disabilities. 
SEC. 2541. ACCESS FOR INDIVIDUALS WITH DISABILITIES. 
Title V of the Rehabilitation Act of 1973 
(29 U.S.C. 791 et seq.) is amended by adding at 
the end of the following: 
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‘‘SEC. 510. STANDARDS FOR ACCESSIBILITY OF MEDICAL DI-
AGNOSTIC EQUIPMENT. 
‘‘(a) STANDARDS.—Not later than 9 months 
after the date of enactment of the America’s Af-
fordable Health Choices Act of 2009, the Archi-
tectural and Transportation Barriers Compli-
ance Board shall issue guidelines setting forth 
the minimum technical criteria for medical di-
agnostic equipment used in (or in conjunction 
with) physician’s offices, clinics, emergency 
rooms, hospitals, and other medical settings. 
The guidelines shall ensure that such equip-
ment is accessible to, and usable by, individ-
uals with disabilities, including provisions to 
ensure independent entry to, use of, and exit 
from the equipment by such individuals to the 
maximum extent possible. 
‘‘(b) MEDICAL DIAGNOSTIC EQUIPMENT COV-
ERED.—The guidelines issued under subsection 
(a) for medical diagnostic equipment shall 
apply to equipment that includes examination 
tables, examination chairs (including chairs 
used for eye examinations or procedures, and 
dental examinations or procedures), weight 
scales, mammography equipment, x-ray ma-
chines, and other equipment commonly used 
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for diagnostic or examination purposes by 
health professionals. 
‘‘(c) INTERIM STANDARDS.—Until the date 
on which final regulations are issued under 
subsection (d), purchases of examination ta-
bles, weight scales, and mammography equip-
ment and used in (or in conjunction with) 
medical settings described in subsection (a), 
shall adhere to the following interim accessi-
bility requirements: 
‘‘(1) 
Examination 
tables 
shall 
be 
height-adjustable between a range of at 
least 18 inches to 37 inches. 
‘‘(2) Weight scales shall be capable of 
weighing individuals who remain seated 
in a wheelchair or other personal mobility 
aid. 
‘‘(3) 
Mammography 
machines 
and 
equipment shall be capable of being used 
by individuals in a standing, seated, or 
recumbent position, including individuals 
who remain seated in a wheelchair or 
other personal mobility aid. 
‘‘(d) 
REGULATIONS.—Not 
later 
than 
months after the date of the issuance of the 
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guidelines under subsection (a), each appro-
priate Federal agency authorized to promul-
gate regulations under this Act or under the 
Americans with Disabilities Act shall— 
‘‘(1) prescribe regulations in an acces-
sible format as necessary to carry out the 
provisions of such Act and section 504 of 
this Act that include accessibility stand-
ards that are consistent with the guide-
lines issued under subsection (a); and 
‘‘(2) ensure that health care providers 
and health care plans covered by the 
America’s Affordable Health Choices Act 
of 2009 meet the requirements of the 
Americans with Disabilities Act and sec-
tion 504, including provisions ensuring 
that individuals with disabilities receive 
equal access to all aspects of the health 
care delivery system. 
‘‘(e) REVIEW
AND
AMEND.—The Architec-
tural and Transportation Barriers Compli-
ance Board shall periodically review and, as 
appropriate, amend the guidelines as pre-
scribed under subsection (a). Not later than 6 
months after the date of the issuance of such 
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revised guidelines, revised regulations con-
sistent with such guidelines shall be promul-
gated in an accessible format by the appro-
priate Federal agencies described in sub-
section (d).’’. 
Subtitle G—Other Grant Programs 
SEC. 2551. REDUCING STUDENT-TO-SCHOOL NURSE RATIOS. 
(a) DEMONSTRATION GRANTS.— 
(1) IN GENERAL.—The Secretary of Edu-
cation, in consultation with the Secretary 
of Health and Human Services and the 
Director of the Centers for Disease Con-
trol and Prevention, may make dem-
onstration grants to eligible local edu-
cation agencies for the purpose of reduc-
ing the student-to-school nurse ratio in 
public elementary and secondary schools. 
(2) 
SPECIAL
CONSIDERATION.—In 
awarding grants under this section, the 
Secretary of Education shall give special 
consideration to applications submitted 
by high-need local educational agencies 
that demonstrate the greatest need for 
new or additional nursing services among 
children in the public elementary and sec-
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ondary schools served by the agency, in 
part by providing information on current 
ratios of students to school nurses. 
(3) MATCHING
FUNDS.—The Secretary 
of Education may require recipients of 
grants under this subsection to provide 
matching funds from non-Federal sources, 
and shall permit the recipients to match 
funds in whole or in part with in-kind 
contributions. 
(b) REPORT.—Not later than 24 months 
after the date on which assistance is first 
made available to local educational agencies 
under this section, the Secretary of Education 
shall submit to the Congress a report on the 
results of the demonstration grant program 
carried out under this section, including an 
evaluation of the effectiveness of the program 
in improving the student-to-school nurse ra-
tios described in subsection (a) and an evalua-
tion of the impact of any resulting enhanced 
health of students on learning. 
(c) DEFINITIONS.—For purposes of this sec-
tion: 
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(1) The terms ‘‘elementary school’’, 
‘‘local educational agency’’, and ‘‘sec-
ondary school’’ have the meanings given 
to those terms in section 9101 of the Ele-
mentary and Secondary Education Act of 
1965 (20 U.S.C. 7801). 
(2) The term ‘‘eligible local edu-
cational agency’’ means a local edu-
cational agency in which the student-to- 
school nurse ratio in the public elemen-
tary and secondary schools served by the 
agency is 750 or more students to every 
school nurse. 
(3) The term ‘‘high-need local edu-
cational agency’’ means a local edu-
cational agency— 
(A) that serves not fewer than 
10,000 children from families with in-
comes below the poverty line; or 
(B) for which not less than 20 per-
cent of the children served by the 
agency are from families with incomes 
below the poverty line. 
(4) The term ‘‘nurse’’ means a licensed 
nurse, as defined under State law. 
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(d) AUTHORIZATION
OF APPROPRIATIONS.— 
To carry out this section, there are authorized 
to be appropriated such sums as may be nec-
essary for each of the fiscal years 2010 through 
2014. 
SEC. 2552. WELLNESS PROGRAM GRANTS. 
(a) ALLOWANCE OF GRANT.— 
(1) IN GENERAL.—For purposes of this 
section, the Secretary of Labor shall 
award wellness grants as determined 
under this section. Wellness program 
grants shall be awarded to qualified em-
ployers for any plan year in an amount 
equal to 50 percent of the costs paid or in-
curred by the employer in connection with 
a qualified wellness program during the 
plan year. For purposes of the preceding 
sentence, in the case of any qualified 
wellness program offered as part of an 
employment-based health plan, only costs 
attributable to the qualified wellness pro-
gram and not to the health plan, or 
health insurance coverage offered in con-
nection with such a plan, may be taken 
into account. 
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(2) LIMITATION.—The amount of the 
grant allowed under paragraph (1) for 
any plan year shall not exceed the sum 
of— 
(A) the product of $200 and the 
number of employees of the employer 
not in excess of 200 employees; plus 
(B) the product of $100 and the 
number of employees of the employer 
in excess of 200 employees. 
The wellness grants awarded to an em-
ployer under this section shall be for up to 
3 years and shall not exceed $50,000. 
(b) QUALIFIED
WELLNESS
PROGRAM.—For 
purposes of this section: 
(1) QUALIFIED
WELLNESS
PROGRAM.— 
The term ‘‘qualified wellness program’’ 
means a program that — 
(A) includes any 3 wellness compo-
nents described in subsection (c); and 
(B) is be certified by the Secretary 
of Labor, in coordination with the 
Health Choices Commissioner and the 
Director of the Center for Disease Con-
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trol and Prevention, as a qualified 
wellness program under this section. 
(2) PROGRAMS
MUST
BE
CONSISTENT 
WITH RESEARCH AND BEST PRACTICES.— 
(A) IN GENERAL.—The Secretary of 
Labor shall not certify a program as a 
qualified wellness program unless the 
program— 
(i) is newly established or in 
existence on the date of enactment 
of this Act but not yet meeting the 
requirements of this section; 
(ii) is consistent with evi-
denced-based researched and best 
practices, as identified by persons 
with expertise in employer health 
promotion and wellness programs; 
(iii) includes multiple, evi-
denced-based strategies which are 
based on the existing and emerg-
ing research and careful scientific 
reviews, including the Guide to 
Community Preventative Services, 
the Guide to Clinical Preventative 
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Services, and the National Reg-
istry for Effective Programs, and 
(iv) includes strategies which 
focus on prevention and support 
for employee populations at risk of 
poor health outcomes. 
(B) PERIODIC
UPDATING
AND
RE-
VIEW.—The Secretary of Labor, in con-
sultation 
with 
other 
appropriate 
agencies shall establish procedures 
for periodic review, evaluation, and 
update of the programs under this 
subsection. 
(3) HEALTH
LITERACY/ACCESSIBILITY.— 
The Secretary of Labor shall, as part of 
the certification process: — 
(A) ensure that employers make 
the programs culturally competent. 
physically and programmatically ac-
cessible (including for individuals 
with disabilities), and appropriate to 
the health literacy needs of the em-
ployees covered by the programs; 
(B) require a health literacy com-
ponent to provide special assistance 
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and materials to employees with low 
literacy skills, limited English and 
from under-served populations; and 
(C) require the Secretary of Labor, 
in consultation with Secretary of 
Health and Human Services, to com-
pile and disseminate to employer 
health plans info on model health lit-
eracy curricula, instructional pro-
grams, 
and 
effective 
intervention 
strategies. 
(c) WELLNESS PROGRAM COMPONENTS.—For 
purposes of this section, the wellness program 
components described in this subsection are 
the following: 
(1) HEALTH AWARENESS COMPONENT.—A 
health awareness component which pro-
vides for the following: 
(A) HEALTH
EDUCATION.—The dis-
semination 
of 
health 
information 
which addresses the specific needs 
and health risks of employees. 
(B) HEALTH SCREENINGS.—The op-
portunity for periodic screenings for 
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health problems and referrals for ap-
propriate follow up measures. 
(2) 
EMPLOYEE
ENGAGEMENT
COMPO-
NENT.—An employee engagement compo-
nent which provides for the active engage-
ment of employees in worksite wellness 
programs through worksite assessments 
and program planning, onsite delivery, 
evaluation, and improvement efforts. 
(3) BEHAVIORAL CHANGE COMPONENT.— 
A behavioral change component which 
provides for altering employee lifestyles to 
encourage healthy living through coun-
seling, seminars, on-line programs, or 
self-help materials which provide tech-
nical assistance and problem solving 
skills. such component may include pro-
grams relating to— 
(A) tobacco use; 
(B) obesity; 
(C) stress management; 
(D) physical fitness; 
(E) nutrition; 
(F) substance abuse; 
(G) depression; and 
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(H) mental health promotion (in-
cluding anxiety). 
(4) SUPPORTIVE
ENVIRONMENT
COMPO-
NENT.—A supportive environment compo-
nent which includes the following: 
(A) 
ON-SITE
POLICIES.—Policies 
and services at the worksite which 
promote a healthy lifestyle, including 
policies relating to— 
(i) tobacco use at the worksite; 
(ii) the nutrition of food avail-
able at the worksite through cafe-
terias and vending options; 
(iii) minimizing stress and 
promoting positive mental health 
in the workplace; and 
(iv) 
the 
encouragement 
of 
physical activity before, during, 
and after work hours. 
(d) 
PARTICIPATION
REQUIREMENT.—No 
grant shall be allowed under subsection (a) 
unless the Secretary of Labor in consultation 
with other appropriate agencies, certifies, as a 
part of any certification described in sub-
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section (b), that each wellness program compo-
nent of the qualified wellness program— 
(1) shall be available to all employees 
of the employer; 
(2) shall not mandate participation by 
employees; and 
(3) shall not require participation by 
individual employees as a condition to ob-
tain a premium discount, rebate, deduct-
ible reduction, or other financial reward. 
(e) PRIVACY PROTECTIONS.—Any employee 
health information collected through partici-
pation in an employer wellness program shall 
be confidential and available only to appro-
priately trained health professions as defined 
by the Secretary of Labor. Employers or em-
ployees of the employer sponsoring a wellness 
program shall have no access to employee 
health data. All entities offering employer- 
sponsored wellness programs shall be consid-
ered ‘‘business associates’’ pursuant to the 
American Reinvestment and Recovery Act and 
must comply with privacy protections restrict-
ing the release of personal medical informa-
tion. 
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(f) DEFINITIONS AND SPECIAL RULES.—For 
purposes of this section: 
(1) QUALIFIED
EMPLOYER.—The term 
‘‘qualified employer’’ means an employer 
that offers a qualified health benefits 
plan to every employee (including each 
employee required to be offered coverage 
under a qualified health benefits plan 
under subtitle B of title III of division A), 
and meets the health coverage participa-
tion requirements as defined in section 
312. 
(2) CERTAIN
COSTS
NOT
INCLUDED.— 
Costs paid or incurred by an employer for 
food or health insurance shall not be 
taken into account under subsection (a). 
(g) OUTREACH.— 
(1) IN GENERAL.—The Secretary of the 
Labor, in conjunction with other appro-
priate agencies and members of the busi-
ness community, shall institute an out-
reach program to inform businesses about 
the availability of the wellness program 
grant as well as to educate businesses on 
how to develop programs according to rec-
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ognized and promising practices and on 
how to measure the success of imple-
mented programs. 
(h) EFFECTIVE DATE.—This section shall 
take effect on January 1, 2013. 
(i) AUTHORIZATION
OF APPROPRIATIONS.— 
There are authorized to be appropriated such 
sums as are necessary to carry out this section. 
SEC. 2553. HEALTH PROFESSIONS TRAINING FOR DIVER-
SITY PROGRAMS. 
Section 171 of the Workforce Investment 
Act of 1998 (29 U.S.C. 2916) is amended by add-
ing at the end the following: 
‘‘(f) HEALTH PROFESSIONS TRAINING FOR DI-
VERSITY PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall 
make available 20 grants of no more than 
$1,000,000 annually to nonprofit organiza-
tions for the purposes of providing work-
force development training program for 
those who are currently employed in the 
health care workforce. 
‘‘(2) ELIGIBILITY.—For the purposes of 
providing assistance and services under 
the program established in this sub-
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section, grants are to be awarded to Area 
Health Education Centers or similar non-
profit organizations involved in the devel-
opment and implementation of health 
care workforce 
development 
programs 
and that— 
‘‘(A) have a formal affiliation with 
a hospital or community health cen-
ter, and institution of higher edu-
cation as defined by section 101 of the 
Higher Education Act of 1965; 
‘‘(B) have a history of providing 
program services to minority popu-
lations; and 
‘‘(C) provide workforce develop-
ment programs to low-income persons, 
veterans, or urban and rural under-
served communities.’’. 
Subtitle H—Long-term Care and 
Family Caregiver Support 
SEC. 2561. LONG-TERM CARE AND FAMILY CAREGIVER SUP-
PORT. 
(a) AMENDMENTS TO THE OLDER AMERICANS 
ACT OF 1965.— 
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(1) PROMOTION OF DIRECT CARE WORK-
FORCE.—Section 202(b)(1) of the Older 
Americans 
Act 
of 
1965 
(42 
U.S.C. 
3012(b)(1)) is amended by inserting before 
the semicolon the following: ‘‘, and, in car-
rying out the purposes of this paragraph, 
shall make recommendations to other 
Federal entities regarding appropriate 
and effective means of identifying, pro-
moting, and implementing investments in 
the direct care workforce necessary to 
meet the growing demand for long-term 
health services and supports and assist-
ing States in developing a comprehensive 
state workforce development plans with 
respect to such workforce including ef-
forts to systematically assess, track, and 
report on workforce adequacy and capac-
ity’’. 
(2) PERSONAL
CARE
ATTENDANT
WORK-
FORCE
ADVISORY
PANEL.—Section 202 of 
such Act (42 U.S.C. 3012) is amended by 
adding at the end the following new sub-
section: 
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‘‘(g)(1) The Assistant Secretary shall estab-
lish a Personal Care Attendant Workforce Ad-
visory Panel and pilot program to improve 
working conditions and training for long term 
care workers, including home health aides, 
certified nurse aides, and personal care at-
tendants. 
‘‘(2) The Panel shall include representa-
tives from— 
‘‘(A) relevant health care agencies 
and facilities (including personal or home 
care agencies, home health care agencies, 
nursing homes and residential care facili-
ties); 
‘‘(B) the disability community; 
‘‘(C) the nursing community; 
‘‘(D) direct care workers (which may 
include unions and national organiza-
tions); 
‘‘(E) older individuals and family 
caregivers; 
‘‘(F) State and federal health care en-
tities; and 
‘‘(G) experts in workforce development 
and adult learning. 
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‘‘(3) Within one year after the establish-
ment of the Panel, the Panel shall submit a re-
port to the Assistant Secretary articulating 
core competencies for eligible personal or 
home care aides necessary to successfully pro-
vide long-term services and supports to eligi-
ble consumers, as well as recommended train-
ing curricula and resources. 
‘‘(4) Within 180 days after receipt by the As-
sistant Secretary of the report under para-
graph (3), the Assistant Secretary shall estab-
lish a 3-year demonstration program in 4 
states to pilot and evaluate the effectiveness of 
the competencies articulated by the Panel and 
the training curricula and training methods 
recommended by the Panel. 
‘‘(5) Not later than 1 year after the comple-
tion of the demonstration program under 
paragraph (4), the Assistant Secretary shall 
submit to each House of the Congress a report 
containing the results of the evaluations by the 
Assistant Secretary pursuant to paragraph 
(4), together with such recommendations for 
legislation or administrative action as the As-
sistant Secretary determines appropriate.’’. 
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(b) AUTHORIZATION OF ADDITIONAL APPRO-
PRIATIONS FOR THE FAMILY CAREGIVER SUPPORT 
PROGRAM UNDER THE OLDER AMERICANS ACT OF 
1965.—Section 303(e)(2) of the Older Ameri-
cans Act of 1965 (42 U.S.C. 3023(e)(2)) is 
amended by striking ‘‘$173,000,000’’ and all 
that follows through ‘‘2011’’, and inserting 
‘‘and $250,000,000 for each of the fiscal years 
2010, 2011, and 2012’’. 
(c) AUTHORIZATION OF ADDITIONAL APPRO-
PRIATIONS FOR THE NATIONAL CLEARINGHOUSE 
FOR LONG-TERM CARE INFORMATION.—There is 
authorized to be appropriated $10,000,000 for 
each of the fiscal years 2010, 2011, and 2012 for 
the operation of the National Clearinghouse 
for Long-Term Care Information established 
by the Secretary of Health and Human Serv-
ices under section 6021(d) of Public Law 109- 
171. 
Subtitle I—Online Resources 
SEC. 2571. WEB SITE ON HEALTH CARE LABOR MARKET AND 
RELATED EDUCATIONAL AND TRAINING OP-
PORTUNITIES. 
(a) IN GENERAL.—The Secretary of Labor, 
in consultation with the National Center for 
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Health Workforce Analysis, shall establish 
and maintain a Web site to serve as a com-
prehensive source of information, searchable 
by workforce region, on the health care labor 
market and related educational and training 
opportunities. 
(b) CONTENTS.—The Web site maintained 
under this section shall include the following: 
(1) Information on the types of jobs 
that are currently or are projected to be 
in high demand in the health care field, 
including— 
(A) salary information; and 
(B) training requirements, such as 
requirements for educational creden-
tials, licensure, or certification. 
(2) Information on training and edu-
cational opportunities within each region 
for the type jobs described in paragraph 
(1), including by— 
(A) type of provider or program 
(such as public, private nonprofit, or 
private for-profit); 
(B) duration; 
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(C) cost (such as tuition, fees, 
books, laboratory expenses, and other 
mandatory costs); 
(D) performance outcomes (such 
as graduation rates, job placement, 
average salary, job retention, and 
wage progression); 
(E) Federal financial aid partici-
pation; 
(F) average graduate loan debt; 
(G) student loan default rates; 
(H) average institutional grant 
aid provided; 
(I) Federal and State accredita-
tion information; and 
(J) other information determined 
by the Secretary. 
(3) A mechanism for searching and 
comparing training and educational op-
tions for specific health care occupations 
to facilitate informed career and edu-
cation choices. 
(4) Financial aid information, includ-
ing with respect to loan forgiveness, loan 
cancellation, loan repayment, stipends, 
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