‘‘(2) REPORT
ON
ALIGNING
PAYMENTS
WITH 
PREVENTION GOALS.—A report that examines and 
describes payment methodologies and presents op-
tions for paying certified prevention health workers 
for clinical preventive care that aligns incentives 
with goals, as well as payment methodologies for 
community organizations involved in the provision of 
prevention services. Such report shall address the 
shortfalls of the payment systems in existence at the 
time of such report that have not proven effective at 
encouraging the provision of prevention services. 
‘‘(3) REPORT ON IDENTIFYING EXISTING FUND-
ING FOR PREVENTION.—A report that examines and 
describes the amount of money spent on prevention 
by public health, public and private health insurers, 
and applicable self-insured health plans (as defined 
in section 399OO) during the most recent year for 
which such data is available. 
‘‘(b) PLAN FOR DELIVERY SYSTEMS.—Not later than 
1 year after the appointment of the Trustees under section 
399LL(c), the Trustees shall establish a plan for deliv-
ering and financing prevention priorities and implement 
pilot programs. Such plan shall include— 
‘‘(1) identifying effective delivery systems based 
on evidence and expert judgment to determine how 
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best to deliver priority clinical and community-based 
prevention activities; 
‘‘(2) assessing the current capacity of effective 
delivery systems and actions necessary to ensure 
adequate infrastructure and capacity to deliver pri-
ority clinical and community-based prevention activi-
ties as determined by the Trust; and 
‘‘(3) identifying cost-saving clinical and commu-
nity-based interventions to implement before Decem-
ber 31, 2011, which shall include evidence-based 
interventions in obesity, diabetes, heart disease, or 
cancer. 
‘‘SEC. 399NN. INFRASTRUCTURE AND PRIORITIES. 
‘‘(a) DESIGNATING NATIONAL PREVENTION PRIOR-
ITIES.—The Trustees shall issue a ranked list of des-
ignated ‘prevention priorities’. The inclusion of an activity 
on such list shall be based on the potential of such activity 
to improve health and the cost effectiveness of such activ-
ity. Such list shall— 
‘‘(1) include clinical preventive services and 
community-based interventions; and 
‘‘(2) be used by the Trustees to— 
‘‘(A) determine what prevention services 
shall be paid for through the Trust Fund under 
section 399OO; 
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‘‘(B) allocate resources within the Trust; 
‘‘(C) educate the public on critical preven-
tion priorities; and 
‘‘(D) emphasize coverage and use within 
existing authorities. 
‘‘(b) CREATION
AND SUPPORT
OF INFRASTRUC-
TURE.—The Trustees shall establish and otherwise sup-
port and sustain the infrastructure for an effective 
wellness system, including the following components: 
‘‘(1) CENTRAL SOURCE OF PREVENTION INFOR-
MATION.—A centralized, national, easily accessible 
information clearinghouse on prevention priorities. 
Such information clearinghouse shall be made avail-
able in multiple media and updated regularly and 
shall connect individuals, health care providers, and 
others to national and local resources. 
‘‘(2) DEVELOPING, IMPLEMENTING, AND MAIN-
TAINING THE ELECTRONIC PREVENTION RECORD.— 
If no nationwide interoperable electronic medical 
record system exists, a privacy-protected electronic 
prevention record or registry to— 
‘‘(A) track provision of prevention over the 
course of individuals’ lifetimes; 
‘‘(B) facilitate reimbursement of certified 
prevention health workers; and 
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‘‘(C) assist in evaluations of the efficacy of 
the policies of the Wellness Trust. 
‘‘(3) TRAINING AND CREDENTIALING PREVEN-
TION HEALTH WORKERS.—Training for prevention 
health workers through agencies such as the Health 
Resources and Services Administration and the Cen-
ters for Disease Control and Prevention. The Trust-
ees shall— 
‘‘(A) provide funding to such agencies 
through the Trust Fund under section 399OO; 
‘‘(B) establish a central registry of cer-
tified prevention health workers; and 
‘‘(C) encourage such workers to access ad-
ditional training. 
‘‘SEC. 399OO. FUNDING FOR WELLNESS TRUST. 
‘‘(a) INITIAL FUNDING.—There is authorized to be 
appropriated and there is appropriated to the Trust Fund 
Board such sums as may be necessary to carry out sec-
tions 399MM and 399NN and other activities necessary 
for the implementation of this part. 
‘‘(b) 
ESTABLISHMENT
OF
WELLNESS
TRUST 
FUND.—Not later than January 1, 2011, there shall be 
established in the Treasury of the United States a trust 
fund to be known as the ‘Wellness Trust Fund’ (referred 
to in this section as the ‘Trust Fund’), consisting of such 
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amounts as are appropriated or credited to the Fund as 
provided under this section. 
‘‘(c) APPROPRIATIONS TO THE FUND.— 
‘‘(1) FISCAL YEAR 2011.—There is hereby ap-
propriated to the Trust Fund for fiscal year 2011 an 
amount equal to the amount spent by all Federal 
health programs to pay for prevention services (as 
defined by the U.S. Preventive Services Task Force) 
in the most recent year for which complete data is 
available, as estimated by the Trustees. 
‘‘(2) FISCAL YEAR 2012.—There is hereby ap-
propriated to the Trust Fund for fiscal year 2012 
the amount appropriated to the Trust Fund for the 
previous fiscal year, increased by the annual percent-
age increase in the medical care component of the 
consumer price index (United States city average) 
for the 12-month period ending with April of the 
preceding fiscal year. 
‘‘(3) FISCAL
YEAR
2013
AND
SUBSEQUENT 
YEARS.—There is hereby appropriated to the Trust 
Fund for fiscal year 2013 and each subsequent fiscal 
year an amount equal to the sum of— 
‘‘(A) the amount appropriated to the Trust 
Fund for the previous fiscal year, increased by 
the annual percentage increase in the medical 
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care component of the consumer price index 
(United States city average) for the 12-month 
period ending with April of the preceding fiscal 
year; 
‘‘(B) the amount collected by the Secretary 
from health insurance issuers and applicable 
self-insured health plans under subsection (d) 
for the fiscal year; and 
‘‘(C) the amount associated with preven-
tion priorities for State and local spending, 
under-use, and the uninsured for the fiscal 
year, as estimated by the Trustees (which shall 
not exceed the amount equal to 10 percent of 
the amount otherwise appropriated to the Trust 
Fund for the fiscal year). 
‘‘(4) 
AVAILABILITY.—Amounts 
appropriated 
pursuant to this subsection shall remain available 
until expended. 
‘‘(d) ASSESSMENT OF HEALTH INSURANCE ISSUERS 
AND APPLICABLE SELF-INSURED HEALTH PLANS.— 
‘‘(1) IN
GENERAL.—Beginning in fiscal year 
2013 and on an annual basis thereafter, the Sec-
retary shall, subject to paragraph (2), assess and 
collect a fee from each health insurance issuer and 
each applicable self-insured health plan in an 
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amount equal to the estimated amount spent by 
such health insurance issuer and self-insured health 
plan, respectively, for prevention services (as defined 
by the U.S. Preventive Services Task Force). 
‘‘(2) COLLECTION
AMOUNT
ADJUSTMENT
BE-
GINNING IN FISCAL YEAR 2013.—The amount deter-
mined under paragraph (1) shall, on an annual 
basis, be increased by the annual percentage in-
crease in the medical care component of the con-
sumer price index (United States city average) for 
the 12-month period ending with April of the pre-
ceding fiscal year. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) 
APPLICABLE
SELF-INSURED
HEALTH 
PLAN.—The term ‘applicable self-insured health 
plan’ means any plan for providing accident or 
health coverage if— 
‘‘(A) any portion of such coverage is pro-
vided other than through an insurance policy; 
and 
‘‘(B) such plan is established or main-
tained— 
‘‘(i) by one or more employers for the 
benefit of their employees or former em-
ployees; 
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‘‘(ii) by one or more employee organi-
zations for the benefit of their members or 
former members; 
‘‘(iii) jointly by one or more employers 
and one or more employee organizations 
for the benefit of employees or former em-
ployees; 
‘‘(iv) by a voluntary employees’ bene-
ficiary association described in section 
501(c)(9) of the Internal Revenue Code of 
1986; 
‘‘(v) by any organization described in 
section 501(c)(6) of such Code; or 
‘‘(vi) in the case of a plan not de-
scribed in the preceding clauses, by a mul-
tiple employer welfare arrangement (as de-
fined in section 3(40) of the Employee Re-
tirement Income Security Act of 1974), a 
rural electric cooperative (as defined in 
section 3(40)(B)(iv) of such Act), or a 
rural telephone cooperative association (as 
defined in section 3(40)(B)(v) of such 
Act). 
‘‘(2) HEALTH INSURANCE ISSUER.—The term 
‘health insurance issuer’ means an insurance com-
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pany, insurance service, or insurance organization 
(including a health maintenance organization, as de-
fined in paragraph (3)) which is licensed to engage 
in the business of insurance in a State and which is 
subject to State law which regulates insurance (with-
in the meaning of section 514(b)(2) of the Employee 
Retirement Income Security Act of 1974). 
‘‘(3) HEALTH MAINTENANCE ORGANIZATION.— 
The 
term 
‘health 
maintenance 
organization’ 
means— 
‘‘(A) a federally qualified health mainte-
nance organization (as defined in section 
1301(a)); 
‘‘(B) an organization recognized under 
State law as a health maintenance organization; 
or 
‘‘(C) a similar organization regulated 
under State law for solvency in the same man-
ner and to the same extent as such a health 
maintenance organization. 
‘‘SEC. 399PP. INSURING PREVENTION PRIORITIES. 
‘‘(a) WELLNESS TRUST AS PRIMARY PAYER FOR 
PREVENTION SERVICES.—The Trust shall enter into con-
tracts with certified prevention health workers to reim-
burse such workers for the prevention services designated 
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by the Trustees under section 399NN(b) as prevention 
priorities. 
‘‘(b) PRIORITIES.—The Trustees shall develop annual 
and 5-year targets for prevention priorities, budgets to 
achieve these targets, and a list of what shall be included 
for funding. Such targets shall include a set-aside for com-
munity-based services. 
‘‘(c) ELIGIBLE INDIVIDUALS.—Pursuant to the con-
tracts described under subsection (a), the Trust shall re-
imburse certified prevention health workers for the preven-
tion services described under such subsection provided to 
all individuals who are United States citizens or legal im-
migrants, without regard to the insurance status of such 
individuals. 
‘‘(d) DEVELOPMENT, REFINEMENT, AND CHANGE OF 
PAYMENT SYSTEMS.—The Trustees shall determine pay-
ment methodologies for prevention priorities. Such pay-
ment methodologies shall correspond to the following tiers 
of activity: 
‘‘(1) COMPETITIVE
CONTRACTING
AUTHOR-
ITY.—The Trustees shall have a competitive con-
tracting authority for the national delivery system 
activities. 
‘‘(2) DIRECT PAYMENT SYSTEMS.—The Trust-
ees shall develop different payment methodologies 
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for the various designated prevention services. These 
payment systems shall take into account existing 
rates, rates for similar services, and whether geo-
graphic adjustment is needed. Such systems shall 
link the priority of the service with payments. 
‘‘(3) USE OF STATE AND LOCAL GRANT SYS-
TEMS.—The Trustees shall utilize existing grant 
programs where feasible to distribute funds from the 
Trust Fund for prevention priorities. 
‘‘(4) REPORTS
FROM
FEDERAL
PROGRAMS.— 
Programs that receive funding for prevention prior-
ities through the Trust Fund shall report annually 
to Congress on the extent to which this funding dis-
places existing spending on prevention priorities. 
‘‘(e) PARTNERSHIP WITH MEDICARE AND OTHER IN-
SURERS.—The Trustees shall determine the most efficient 
way to transfer funds from the Trust Fund to certified 
prevention health workers. In making such determination, 
the Trustees shall carry out the following: 
‘‘(1) COORDINATION
WITH
MEDICARE.—The 
Trustees shall examine the use of Medicare systems 
for direct payments to certified prevention health 
workers. Any additional administrative cost associ-
ated with the use of the payment systems, including 
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