260 
Act (42 U.S.C. 300u–6) who is entitled to benefits 
under part A, and enrolled under part B, of title 
XVIII of the Social Security Act. 
(b) PROGRAM DESIGN.— 
(1) INITIAL DESIGN.—Not later than 1 year 
after the date of the enactment of this Act, the Sec-
retary shall evaluate best practices in the private 
sector, community programs, and academic research 
of methods that reduce disparities among individuals 
of racial and ethnic minority groups in the preven-
tion and treatment of cancer and shall design the 
demonstration projects based on such evaluation. 
(2) NUMBER AND PROJECT AREAS.—Not later 
than 2 years after the date of the enactment of this 
Act, the Secretary shall implement at least nine 
demonstration projects, including the following: 
(A) Two projects for each of the four fol-
lowing major racial and ethnic minority groups: 
(i) American Indians and Alaska Na-
tives, Eskimos and Aleuts. 
(ii) Asian Americans. 
(iii) Blacks/African Americans. 
(iv) Hispanic/Latino Americans. 
(v) Native Hawaiians and other Pa-
cific Islanders. 
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The two projects must target different ethnic 
subpopulations. 
(B) One project within the Pacific Islands 
or United States insular areas. 
(C) At least one project each in a rural 
area and inner-city area. 
(3) EXPANSION
OF
PROJECTS; IMPLEMENTA-
TION
OF
DEMONSTRATION
PROJECT
RESULTS.—If 
the initial report under subsection (c) contains an 
evaluation that demonstration projects— 
(A) reduce expenditures under the Medi-
care program under title XVIII of the Social 
Security Act; or 
(B) do not increase expenditures under the 
Medicare program and reduce racial and ethnic 
health disparities in the quality of health care 
services provided to target individuals and in-
crease satisfaction of beneficiaries and health 
care providers; 
the Secretary shall continue the existing demonstra-
tion projects and may expand the number of dem-
onstration projects. 
(c) REPORT TO CONGRESS.— 
(1) IN GENERAL.—Not later than 2 years after 
the date the Secretary implements the initial dem-
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onstration projects, and biannually thereafter, the 
Secretary shall submit to Congress a report regard-
ing the demonstration projects. 
(2) CONTENTS OF REPORT.—Each report under 
paragraph (1) shall include the following: 
(A) A description of the demonstration 
projects. 
(B) An evaluation of— 
(i) the cost-effectiveness of the dem-
onstration projects; 
(ii) the quality of the health care serv-
ices provided to target individuals under 
the demonstration projects; and 
(iii) beneficiary and health care pro-
vider satisfaction under the demonstration 
projects. 
(C) Any other information regarding the 
demonstration projects that the Secretary de-
termines to be appropriate. 
(d) WAIVER AUTHORITY.—The Secretary shall waive 
compliance with the requirements of title XVIII of the So-
cial Security Act to such extent and for such period as 
the Secretary determines is necessary to conduct dem-
onstration projects. 
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SEC. 517. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV-
IORS IN WOMEN AND CHILDREN. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended— 
(1) by redesignating the second and third sec-
tions 399R (added by Public Laws 110–373 and 
110–374) as sections 399S and 399T, respectively; 
and 
(2) by adding at the end the following: 
‘‘SEC. 399U. GRANTS TO PROMOTE POSITIVE HEALTH BE-
HAVIORS IN WOMEN AND CHILDREN. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col-
laboration with the Director of the Centers for Disease 
Control and Prevention and other Federal officials deter-
mined appropriate by the Secretary, is authorized to 
award grants to eligible entities to promote positive health 
behaviors for women and children in target populations, 
especially racial and ethnic minority women and children 
in medically underserved communities. 
‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 
subsection (a) may be used to support community health 
workers— 
‘‘(1) to educate and provide outreach regarding 
enrollment in health insurance including the State 
Children’s Health Insurance Program under title 
XXI of the Social Security Act, Medicare under title 
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XVIII of such Act, and Medicaid under title XIX of 
such Act; 
‘‘(2) to educate, guide, and provide outreach in 
a community setting regarding health problems prev-
alent among women and children and especially 
among racial and ethnic minority women and chil-
dren; 
‘‘(3) to educate, guide, and provide experiential 
learning opportunities that target behavioral risk 
factors including— 
‘‘(A) poor nutrition; 
‘‘(B) physical inactivity; 
‘‘(C) being overweight or obese; 
‘‘(D) tobacco use; 
‘‘(E) alcohol and substance use; 
‘‘(F) injury and violence; 
‘‘(G) risky sexual behavior; 
‘‘(H) mental health problems; 
‘‘(I) dental and oral health problems; and 
‘‘(J) understanding informed consent; 
‘‘(4) to educate and guide regarding effective 
strategies to promote positive health behaviors with-
in the family; 
‘‘(5) to promote community wellness and aware-
ness; and 
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‘‘(6) to educate and refer target populations to 
appropriate health care agencies and community- 
based programs and organizations in order to in-
crease access to quality health care services, includ-
ing preventive health services. 
‘‘(c) APPLICATION.— 
‘‘(1) IN
GENERAL.—Each eligible entity that 
desires to receive a grant under subsection (a) shall 
submit an application to the Secretary, at such time, 
in such manner, and accompanied by such additional 
information as the Secretary may require. 
‘‘(2) CONTENTS.—Each application submitted 
pursuant to paragraph (1) shall— 
‘‘(A) describe the activities for which as-
sistance under this section is sought; 
‘‘(B) contain an assurance that with re-
spect to each community health worker pro-
gram receiving funds under the grant awarded, 
such program provides training and supervision 
to community health workers to enable such 
workers to provide authorized program services; 
‘‘(C) contain an assurance that the appli-
cant will evaluate the effectiveness of commu-
nity health worker programs receiving funds 
under the grant; 
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‘‘(D) contain an assurance that each com-
munity health worker program receiving funds 
under the grant will provide services in the cul-
tural context most appropriate for the individ-
uals served by the program; 
‘‘(E) contain a plan to document and dis-
seminate project description and results to 
other States and organizations as identified by 
the Secretary; and 
‘‘(F) describe plans to enhance the capac-
ity of individuals to utilize health services and 
health-related social services under Federal, 
State, and local programs by— 
‘‘(i) assisting individuals in estab-
lishing eligibility under the programs and 
in receiving the services or other benefits 
of the programs; and 
‘‘(ii) providing other services as the 
Secretary determines to be appropriate, 
that may include transportation and trans-
lation services. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to those appli-
cants— 
‘‘(1) who propose to target geographic areas— 
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‘‘(A) with a high percentage of residents 
who are eligible for health insurance but are 
uninsured or underinsured; and 
‘‘(B) with a high percentage of families for 
whom English is not their primary language. 
‘‘(2) with experience in providing health or 
health-related social services to individuals who are 
underserved with respect to such services; and 
‘‘(3) with documented community activity and 
experience with community health workers. 
‘‘(e) COLLABORATION WITH ACADEMIC INSTITU-
TIONS.—The Secretary shall encourage community health 
worker programs receiving funds under this section to col-
laborate with academic institutions, including minority- 
serving institutions. Nothing in this section shall be con-
strued to require such collaboration. 
‘‘(f) QUALITY ASSURANCE
AND COST-EFFECTIVE-
NESS.—The Secretary shall establish guidelines for assur-
ing the quality of the training and supervision of commu-
nity health workers under the programs funded under this 
section and for assuring the cost-effectiveness of such pro-
grams. 
‘‘(g) MONITORING.—The Secretary shall monitor 
community health worker programs identified in approved 
applications and shall determine whether such programs 
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are in compliance with the guidelines established under 
subsection (f). 
‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to community health worker 
programs identified in approved applications with respect 
to planning, developing, and operating programs under the 
grant. 
‘‘(i) REPORT TO CONGRESS.— 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date on which the Secretary first awards 
grants under subsection (a), the Secretary shall sub-
mit to Congress a report regarding the grant 
project. 
‘‘(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
‘‘(A) A description of the programs for 
which grant funds were used. 
‘‘(B) The number of individuals served. 
‘‘(C) An evaluation of— 
‘‘(i) the effectiveness of these pro-
grams; 
‘‘(ii) the cost of these programs; and 
‘‘(iii) the impact of the project on the 
health outcomes of the community resi-
dents. 
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‘‘(D) Recommendations for sustaining the 
community health worker programs developed 
or assisted under this section. 
‘‘(E) Recommendations regarding training 
to enhance career opportunities for community 
health workers. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health, including dental, oral, mental, 
and environmental health, or nutrition needs; 
and 
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‘‘(F) by providing referral and followup 
services. 
‘‘(2) COMMUNITY SETTING.—The term ‘commu-
nity setting’ means a home or a community organi-
zation located in the neighborhood in which a partic-
ipant resides. 
‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means— 
‘‘(A) a unit of State, territorial, local, or 
tribal government (including a federally recog-
nized tribe or Alaska native villages); or 
‘‘(B) a community-based organization. 
‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ means 
a community— 
‘‘(A) that has a substantial number of in-
dividuals who are members of a medically un-
derserved population, as defined by section 
330(b)(3); and 
‘‘(B) a significant portion of which is a 
health professional shortage area as designated 
under section 332. 
‘‘(5) SUPPORT.—The term ‘support’ means the 
provision of training, supervision, and materials 
needed to effectively deliver the services described in 
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subsection (b), reimbursement for services, and 
other benefits. 
‘‘(6) TARGET POPULATION.—The term ‘target 
population’ means women of reproductive age, re-
gardless of their current childbearing status and 
children under 21 years of age. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$15,000,000 for each of fiscal years 2010, 2011, 2012, 
2013, and 2014.’’. 
SEC. 518. EXCEPTION FOR CITIZENS OF FREELY ASSOCI-
ATED STATES. 
(a) IN GENERAL.—Section 402(a)(2) of the Personal 
Responsibility and Work Opportunity Reconciliation Act 
of 1996 (8 U.S.C. 1612(a)(2)) is amended by adding at 
the end the following: 
‘‘(N) EXCEPTION FOR CITIZENS OF FREE-
LY ASSOCIATED STATES.—With respect to eligi-
bility for benefits for the specified Federal pro-
grams described in paragraph (3), paragraph 
(1) shall not apply to any individual who law-
fully resides in the United States (including ter-
ritories and possessions of the United States) in 
accordance with— 
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‘‘(i) section 141 of the Compact of 
Free Association between the Government 
of the United States and the Government 
of the Federated States of Micronesia, ap-
proved by Congress in the Compact of 
Free Association Amendments Act of 
2003; 
‘‘(ii) section 141 of the Compact of 
Free Association between the Government 
of the United States and the Government 
of the Republic of the Marshall Islands, 
approved by Congress in the Compact of 
Free Association Amendments Act of 
2003; or 
‘‘(iii) section 141 of the Compact of 
Free Association between the Government 
of the United States and the Government 
of Palau, approved by Congress in Public 
Law 99–658 (100 Stat. 3672).’’. 
(b) MEDICAID EXCEPTION.—Section 402(b)(2) of the 
Personal Responsibility and Work Opportunity Reconcili-
ation Act of 1996 (8 U.S.C. 1612(b)(2)) is amended by 
adding at the end the following: 
‘‘(G) MEDICAID
EXCEPTIONS
FOR
CITI-
ZENS OF FREELY ASSOCIATED STATES.—With 
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respect to eligibility for benefits for the pro-
grams defined in subparagraphs (A) and (C) of 
paragraph (3) (relating to Medicaid), paragraph 
(1) shall not apply to any individual who law-
fully resides in the United States (including ter-
ritories and possessions of the United States) in 
accordance with a Compact of Free Association 
referred to in subsection (a)(2)(N).’’. 
(c) QUALIFIED ALIEN.—Section 431(b) of the Per-
sonal Responsibility and Work Opportunity Reconciliation 
Act of 1996 (8 U.S.C. 1641(b)) is amended— 
(1) in paragraph (6), by striking ‘‘or’’ at the 
end; 
(2) in paragraph (7), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following: 
‘‘(8) an individual who lawfully resides in the 
United States (including territories and possessions 
of the United States) in accordance with a Compact 
of 
Free 
Association 
referred 
to 
in 
section 
402(a)(2)(N).’’. 
(d) INCREASED FMAP.—The third sentence of sec-
tion 1905(b) of the Social Security Act (42 U.S.C. 
1396d(b)) is amended by inserting before the period at 
the end the following: ‘‘and for services furnished to indi-
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viduals described in section 431(b)(8) of the Personal Re-
sponsibility and Work Opportunity Reconciliation Act of 
1996’’. 
SEC. 519. MEDICARE GRADUATE MEDICAL EDUCATION. 
(a) CLARIFICATION OF CONGRESSIONAL INTENT RE-
GARDING THE COUNTING OF RESIDENTS IN A NONHOS-
PITAL SETTING.— 
(1) D–GME.—Section 1886(h)(4)(E) of the So-
cial Security Act (42 U.S.C. 1395ww(h)(4)(E)) is 
amended by adding at the end the following new 
sentences: ‘‘For purposes of the preceding sentence, 
the term ‘all, or substantially all, of the costs for the 
training program’ means the stipends and benefits 
provided to the resident and other amounts, if any, 
as determined by the hospital and the entity oper-
ating the nonhospital setting. The hospital is not re-
quired to pay the entity any amounts other than 
those determined by the hospital and the entity in 
order for the hospital to be considered to have in-
curred all, or substantially all, of the costs for the 
training program in that setting.’’. 
(2) IME.—Section 1886(d)(5)(B)(iv) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is 
amended by adding at the end the following new 
sentences: ‘‘For purposes of the preceding sentence, 
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the term ‘all, or substantially all, of the costs for the 
training program’ means the stipends and benefits 
provided to the resident and other amounts, if any, 
as determined by the hospital and the entity oper-
ating the nonhospital setting. The hospital is not re-
quired to pay the entity any amounts other than 
those determined by the hospital and the entity in 
order for the hospital to be considered to have in-
curred all, or substantially all, of the costs for the 
training program in that setting.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2010. 
(b) CLARIFICATION OF ELIGIBILITY OF A NONRURAL 
HOSPITAL THAT HAS A TRAINING PROGRAM WITH AN 
INTEGRATED RURAL TRACK.— 
(1) IN
GENERAL.—Section 1886(h)(4)(H) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(h)(4)(H)) is amended— 
(A) in clause (iv), by inserting ‘‘(as defined 
in clause (vi))’’ after ‘‘an integrated rural 
track’’; and 
(B) by adding at the end the following new 
clause: 
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‘‘(vi) DEFINITION
OF
ACCREDITED 
TRAINING PROGRAM WITH AN INTEGRATED 
RURAL
TRACK.—For purposes of clause 
(iv), the term ‘accredited training program 
with an integrated rural track’ means an 
accredited medical residency training pro-
gram located in an urban area which offers 
a curriculum for all residents in the pro-
gram that includes the following character-
istics: 
‘‘(I) A minimum of 3 block 
months of rural rotations. During 
such 3 block months, the resident is 
in a rural area for 4 weeks or a 
month. 
‘‘(II) A stated mission for train-
ing rural physicians. 
‘‘(III) A minimum of 3 months of 
obstetrical training, or an equivalent 
longitudinal experience. 
‘‘(IV) A minimum of 4 months of 
pediatric training that includes neo-
natal, 
ambulatory, 
inpatient, 
and 
emergency experiences through rota-
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‘‘(3) The term ‘mental health counselor services’ 
means services performed by a mental health counselor (as 
defined in paragraph (4)) for the diagnosis and treatment 
of mental illnesses which the mental health counselor is 
legally authorized to perform under State law (or the 
State regulatory mechanism provided by the State law) of 
the State in which such services are performed, as would 
otherwise be covered if furnished by a physician or as inci-
dent to a physician’s professional service, but only if no 
facility or other provider charges or is paid any amounts 
with respect to the furnishing of such services. 
‘‘(4) The term ‘mental health counselor’ means an 
individual who— 
‘‘(A) possesses a master’s or doctor’s degree in 
mental health counseling or a related field; 
‘‘(B) after obtaining such a degree has per-
formed at least 2 years of supervised mental health 
counselor practice; and 
‘‘(C) in the case of an individual performing 
services in a State that provides for licensure or cer-
tification of mental health counselors or professional 
counselors, is licensed or certified as a mental health 
counselor or professional counselor in such State.’’. 
(3) PROVISION
FOR
PAYMENT
UNDER
PART 
B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 
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