784 
(1) IN GENERAL.—Title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.) is amended by 
inserting after section 1920B the following: 
‘‘PRESUMPTIVE ELIGIBILITY FOR FAMILY PLANNING 
SERVICES 
‘‘SEC. 1920C. (a) STATE OPTION.—State plan ap-
proved under section 1902 may provide for making med-
ical assistance available to an individual described in sec-
tion 1902(hh) (relating to individuals who meet certain 
income eligibility standard) during a presumptive eligi-
bility period. In the case of an individual described in sec-
tion 1902(hh), such medical assistance shall be limited to 
family planning services and supplies described in 
1905(a)(4)(C) and, at the State’s option, medical diag-
nosis and treatment services that are provided in conjunc-
tion with a family planning service in a family planning 
setting. 
‘‘(b) DEFINITIONS.—For purposes of this section: 
‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The 
term ‘presumptive eligibility period’ means, with re-
spect to an individual described in subsection (a), 
the period that— 
‘‘(A) begins with the date on which a 
qualified entity determines, on the basis of pre-
liminary information, that the individual is de-
scribed in section 1902(hh); and 
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‘‘(B) ends with (and includes) the earlier 
of— 
‘‘(i) the day on which a determination 
is made with respect to the eligibility of 
such individual for services under the State 
plan; or 
‘‘(ii) in the case of such an individual 
who does not file an application by the last 
day of the month following the month dur-
ing which the entity makes the determina-
tion referred to in subparagraph (A), such 
last day. 
‘‘(2) QUALIFIED ENTITY.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘qualified entity’ means 
any entity that— 
‘‘(i) is eligible for payments under a 
State plan approved under this title; and 
‘‘(ii) is determined by the State agen-
cy to be capable of making determinations 
of the type described in paragraph (1)(A). 
‘‘(B) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as pre-
venting a State from limiting the classes of en-
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tities that may become qualified entities in 
order to prevent fraud and abuse. 
‘‘(c) ADMINISTRATION.— 
‘‘(1) IN GENERAL.—The State agency shall pro-
vide qualified entities with— 
‘‘(A) such forms as are necessary for an 
application to be made by an individual de-
scribed in subsection (a) for medical assistance 
under the State plan; and 
‘‘(B) information on how to assist such in-
dividuals in completing and filing such forms. 
‘‘(2) NOTIFICATION REQUIREMENTS.—A quali-
fied 
entity 
that 
determines 
under 
subsection 
(b)(1)(A) that an individual described in subsection 
(a) is presumptively eligible for medical assistance 
under a State plan shall— 
‘‘(A) notify the State agency of the deter-
mination within 5 working days after the date 
on which determination is made; and 
‘‘(B) inform such individual at the time 
the determination is made that an application 
for medical assistance is required to be made by 
not later than the last day of the month fol-
lowing the month during which the determina-
tion is made. 
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‘‘(3) 
APPLICATION
FOR
MEDICAL
ASSIST-
ANCE.—In the case of an individual described in 
subsection (a) who is determined by a qualified enti-
ty to be presumptively eligible for medical assistance 
under a State plan, the individual shall apply for 
medical assistance by not later than the last day of 
the month following the month during which the de-
termination is made. 
‘‘(d) PAYMENT.—Notwithstanding any other provi-
sion of law, medical assistance that— 
‘‘(1) is furnished to an individual described in 
subsection (a)— 
‘‘(A) during a presumptive eligibility pe-
riod; 
‘‘(B) by a entity that is eligible for pay-
ments under the State plan; and 
‘‘(2) is included in the care and services covered 
by the State plan, 
shall be treated as medical assistance provided by such 
plan for purposes of clause (4) of the first sentence of 
section 1905(b).’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1902(a)(47) of the Social Se-
curity Act (42 U.S.C. 1396a(a)(47)) is amend-
ed by inserting before the semicolon at the end 
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the following: ‘‘and provide for making medical 
assistance available to individuals described in 
subsection (a) of section 1920C during a pre-
sumptive eligibility period in accordance with 
such section’’. 
(B) Section 1903(u)(1)(D)(v) of such Act 
(42 U.S.C. 1396b(u)(1)(D)(v)) is amended— 
(i) by striking ‘‘or for’’ and inserting 
‘‘for’’; and 
(ii) by inserting before the period the 
following: ‘‘, or for medical assistance pro-
vided to an individual described in sub-
section (a) of section 1920C during a pre-
sumptive eligibility period under such sec-
tion’’. 
(c) CLARIFICATION OF COVERAGE OF FAMILY PLAN-
NING SERVICES AND SUPPLIES.—Section 1937(b) of the 
Social Security Act (42 U.S.C. 1396u–7(b)) is amended 
by adding at the end the following: 
‘‘(5) COVERAGE OF FAMILY PLANNING SERV-
ICES AND SUPPLIES.—Notwithstanding the previous 
provisions of this section, a State may not provide 
for medical assistance through enrollment of an indi-
vidual with benchmark coverage or benchmark-equiv-
alent coverage under this section unless such cov-
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789 
erage includes for any individual described in section 
1905(a)(4)(C), medical assistance for family plan-
ning services and supplies in accordance with such 
section.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section take effect on the date of the enactment of 
this Act and shall apply to items and services furnished 
on or after such date. 
Subtitle C—Access 
SEC. 1721. PAYMENTS TO PRIMARY CARE PRACTITIONERS. 
(a) IN GENERAL.— 
(1) 
FEE-FOR-SERVICE
PAYMENTS.—Section 
1902(a)(13) of the Social Security Act (42 U.S.C. 
1396b(a)(13)) is amended— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (A); 
(B) by adding ‘‘and’’ at the end of sub-
paragraph (B); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) payment for primary care services (as 
defined in section 1848(j)(5)(A), but applied 
without regard to clause (ii) thereof) furnished 
by physicians (or for services furnished by other 
health care professionals that would be primary 
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790 
care services under such section if furnished by 
a physician) at a rate not less than 80 percent 
of the payment rate applicable to such services 
and physicians or professionals (as the case 
may be) under part B of title XVIII for services 
furnished in 2010, 90 percent of such rate for 
services and physicians (or professionals) fur-
nished in 2011, and 100 percent of such pay-
ment rate for services and physicians (or pro-
fessionals) furnished in 2012 or a subsequent 
year;’’. 
(2) 
UNDER
MEDICAID
MANAGED
CARE 
PLANS.—Section 1923(f) of such Act (42 U.S.C. 
1396u–2(f)) is amended— 
(A) in the heading, by adding at the end 
the following: ‘‘; ADEQUACY OF PAYMENT FOR 
PRIMARY CARE SERVICES’’; and 
(B) by inserting before the period at the 
end the following: ‘‘and, in the case of primary 
care 
services 
described 
in 
section 
1902(a)(13)(C), consistent with the minimum 
payment rates specified in such section (regard-
less of the manner in which such payments are 
made, including in the form of capitation or 
partial capitation)’’. 
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791 
(b) INCREASE IN PAYMENT USING 100% FMAP.— 
Section 1905(y), as added by section 1701(a)(2)(B) and 
as amended by section 1701(c)(2), is amended by adding 
at the end the following: 
‘‘(3)(A) The portion of the amounts expended 
for medical assistance for services described in sec-
tion 1902(a)(13)(C) furnished on or after January 
1, 2010, that is attributable to the amount by which 
the minimum payment rate required under such sec-
tion (or, by application, section 1932(f)) exceeds the 
payment rate applicable to such services under the 
State plan as of June 16, 2009. 
‘‘(B) Subparagraphs (A) shall not be construed 
as preventing the payment of Federal financial par-
ticipation based on the Federal medical assistance 
percentage for amounts in excess of those specified 
under such subparagraphs.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2010. 
SEC. 1722. MEDICAL HOME PILOT PROGRAM. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall establish under this section a med-
ical home pilot program under which a State may apply 
to the Secretary for approval of a medical home pilot 
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792 
project described in subsection (b) (in this section referred 
to as a ‘‘pilot project’’) for the application of the medical 
home concept under title XIX of the Social Security Act. 
The pilot program shall operate for a period of up to 5 
years. 
(b) PILOT PROJECT DESCRIBED.— 
(1) IN GENERAL.—A pilot project is a project 
that applies one or more of the medical home models 
described in section 1866E(a)(3) of the Social Secu-
rity Act (as inserted by section 1302(a)) or such 
other model as the Secretary may approve, to high 
need beneficiaries (including medically fragile chil-
dren and high-risk pregnant women) who are eligible 
for medical assistance under title XIX of the Social 
Security Act. The Secretary shall provide for appro-
priate coordination of the pilot program under this 
section with the medical home pilot program under 
section 1866E of such Act. 
(2) LIMITATION.—A pilot project shall be for a 
duration of not more than 5 years. 
(c) ADDITIONAL INCENTIVES.—In the case of a pilot 
project, the Secretary may— 
(1) 
waive 
the 
requirements 
of 
section 
1902(a)(1) of the Social Security Act (relating to 
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793 
statewideness) and section 1902(a)(10)(B) of such 
Act (relating to comparability); and 
(2) increase to up to 90 percent (for the first 
2 years of the pilot program) or 75 percent (for the 
next 3 years) the matching percentage for adminis-
trative expenditures (such as those for community 
care workers). 
(d) MEDICALLY FRAGILE CHILDREN.—In the case of 
a model involving medically fragile children, the model 
shall ensure that the patient-centered medical home serv-
ices received by each child, in addition to fulfilling the re-
quirements under 1866E(b)(1) of the Social Security Act, 
provide for continuous involvement and education of the 
parent or caregiver and for assistance to the child in ob-
taining necessary transitional care if a child’s enrollment 
ceases for any reason. 
(e) EVALUATION; REPORT.— 
(1) EVALUATION.—The Secretary, using the 
criteria described in section 1866E(g)(1) of the So-
cial Security Act (as inserted by section 1123), shall 
conduct an evaluation of the pilot program under 
this section. 
(2) REPORT.—Not later than 60 days after the 
date of completion of the evaluation under para-
graph (1), the Secretary shall submit to Congress 
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794 
and make available to the public a report on the 
findings of the evaluation under such paragraph. 
(f) FUNDING.—The additional Federal financial par-
ticipation resulting from the implementation of the pilot 
program under this section may not exceed in the aggre-
gate $1,235,000,000 over the 5-year period of the pro-
gram. 
SEC. 1723. TRANSLATION OR INTERPRETATION SERVICES. 
(a) IN GENERAL.—Section 1903(a)(2)(E) of the So-
cial Security Act (42 U.S.C. 1396b(a)(2)), as added by 
section 201(b)(2)(A) of the Children’s Health Insurance 
Program Reauthorization Act of 2009 (Public Law 111– 
3), is amended by inserting ‘‘and other individuals’’ after 
‘‘children of families’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to payment for translation or 
interpretation services furnished on or after January 1, 
2010. 
SEC. 1724. OPTIONAL COVERAGE FOR FREESTANDING 
BIRTH CENTER SERVICES. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d), as amended by section 
1713(a), is amended— 
(1) in subsection (a)— 
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(A) by redesignating paragraph (29) as 
paragraph (30); 
(B) in paragraph (28), by striking at the 
end ‘‘and’’; and 
(C) by inserting after paragraph (28) the 
following new paragraph: 
‘‘(29) freestanding birth center services (as de-
fined in subsection (l)(3)(A)) and other ambulatory 
services that are offered by a freestanding birth cen-
ter (as defined in subsection (l)(3)(B)) and that are 
otherwise included in the plan; and’’; and 
(2) in subsection (l), by adding at the end the 
following new paragraph: 
‘‘(3)(A) The term ‘freestanding birth center services’ 
means services furnished to an individual at a freestanding 
birth center (as defined in subparagraph (B)), including 
by a licensed birth attendant (as defined in subparagraph 
(C)) at such center. 
‘‘(B) The term ‘freestanding birth center’ means a 
health facility— 
‘‘(i) that is not a hospital; and 
‘‘(ii) where childbirth is planned to occur away 
from the pregnant woman’s residence. 
‘‘(C) The term ‘licensed birth attendant’ means an 
individual who is licensed or registered by the State in-
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796 
volved to provide health care at childbirth and who pro-
vides such care within the scope of practice under which 
the individual is legally authorized to perform such care 
under State law (or the State regulatory mechanism pro-
vided by State law), regardless of whether the individual 
is under the supervision of, or associated with, a physician 
or other health care provider. Nothing in this subpara-
graph shall be construed as changing State law require-
ments applicable to a licensed birth attendant.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after the date of the enactment of this Act. 
SEC. 1725. INCLUSION OF PUBLIC HEALTH CLINICS UNDER 
THE VACCINES FOR CHILDREN PROGRAM. 
Section 1928(b)(2)(A)(iii)(I) of the Social Security 
Act (42 U.S.C. 1396s(b)(2)(A)(iii)(I)) is amended— 
(1) by striking ‘‘or a rural health clinic’’ and in-
serting ‘‘, a rural health clinic’’; and 
(2) by inserting ‘‘or a public health clinic,’’ 
after ‘‘‘1905(l)(1)),’’. 
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798 
‘‘(3) whose resources (as determined under the 
State plan under this title with respect to disabled 
individuals) do not exceed the maximum amount of 
resources a disabled individual described in sub-
section (a)(10)(A)(i) may have and obtain medical 
assistance under the plan.’’. 
(b) ENHANCED MATCH.—The first sentence of sec-
tion 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended 
by striking ‘‘section 1902(a)(10)(A)(ii)(XVIII)’’ and in-
serting 
‘‘subclause 
(XVIII) 
or 
(XX) 
of 
section 
1902(a)(10)(A)(ii)’’. 
(c) CONFORMING AMENDMENTS.—Section 1905(a) of 
such Act (42 U.S.C. 1396d(a)) is amended, in the matter 
preceding paragraph (1)— 
(1) by striking ‘‘or’’ at the end of clause (xii); 
(2) by adding ‘‘or’’ at the end of clause (xiii); 
and 
(3) by inserting after clause (xiii) the following: 
‘‘(xiv) individuals described in section 
1902(ii),’’. 
(d) EXEMPTION FROM FUNDING LIMITATION FOR 
TERRITORIES.—Section 1108(g) of the Social Security 
Act (42 U.S.C. 1308(g)) is amended by adding at the end 
the following: 
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‘‘(5) DISREGARDING MEDICAL ASSISTANCE FOR 
OPTIONAL
LOW-INCOME
HIV-INFECTED
INDIVID-
UALS.—The limitations under subsection (f) and the 
previous provisions of this subsection shall not apply 
to amounts expended for medical assistance for indi-
viduals described in section 1902(ii) who are only el-
igible for such assistance on the basis of section 
1902(a)(10)(A)(ii)(XX).’’. 
(e) EFFECTIVE DATE; SUNSET.—The amendments 
made by this section shall apply to expenditures for cal-
endar quarters beginning on or after the date of the enact-
ment of this Act, and before January 1, 2013, without 
regard to whether or not final regulations to carry out 
such amendments have been promulgated by such date. 
SEC. 1732. EXTENDING TRANSITIONAL MEDICAID ASSIST-
ANCE (TMA). 
Sections 1902(e)(1)(B) and 1925(f) of the Social Se-
curity Act (42 U.S.C. 1396a(e)(1)(B), 1396r–6(f)), as 
amended by section 5004(a)(1) of the American Recovery 
and Reinvestment Act of 2009 (Public Law 111–5), are 
each amended by striking ‘‘December 31, 2010’’ and in-
serting ‘‘December 31, 2012’’. 
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800 
SEC. 1733. REQUIREMENT OF 12-MONTH CONTINUOUS COV-
ERAGE UNDER CERTAIN CHIP PROGRAMS. 
(a) IN GENERAL.—Section 2102(b) of the Social Se-
curity Act (42 U.S.C. 1397bb(b)) is amended by adding 
at the end the following new paragraph: 
‘‘(6) REQUIREMENT
FOR
12-MONTH
CONTIN-
UOUS ELIGIBILITY.—In the case of a State child 
health plan that provides child health assistance 
under this title through a means other than de-
scribed in section 2101(a)(2), the plan shall provide 
for implementation under this title of the 12-month 
continuous eligibility option described in section 
1902(e)(12) for targeted low-income children whose 
family income is below 200 percent of the poverty 
line.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to determinations (and redeter-
minations) of eligibility made on or after January 1, 2010. 
Subtitle E—Financing 
SEC. 1741. PAYMENTS TO PHARMACISTS. 
(a) PHARMACY REIMBURSEMENT LIMITS.— 
(1) IN GENERAL.—Section 1927(e) of the So-
cial Security Act (42 U.S.C. 1396r–8(e)) is amend-
ed— 
(A) by striking paragraph (5) and insert-
ing the following: 
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801 
‘‘(5) USE OF AMP IN UPPER PAYMENT LIM-
ITS.—The Secretary shall calculate the Federal 
upper reimbursement limit established under para-
graph (4) as 130 percent of the weighted average 
(determined on the basis of manufacturer utiliza-
tion) of monthly average manufacturer prices.’’. 
(2) 
DEFINITION
OF
AMP.—Section 
1927(k)(1)(B) of such Act (42 U.S.C. 1396r– 
8(k)(1)(B)) is amended— 
(B) in the heading, by striking ‘‘EX-
TENDED
TO
WHOLESALERS’’ and inserting 
‘‘AND OTHER PAYMENTS’’; and 
(C) by striking ‘‘regard to’’ and all that 
follows through the period and inserting the fol-
lowing: ‘‘regard to— 
‘‘(i) customary prompt pay discounts 
extended to wholesalers; 
‘‘(ii) bona fide service fees paid by 
manufacturers; 
‘‘(iii) reimbursement by manufactur-
ers for recalled, damaged, expired, or oth-
erwise unsalable returned goods, including 
reimbursement for the cost of the goods 
and any reimbursement of costs associated 
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802 
with return goods handling and processing, 
reverse logistics, and drug destruction; 
‘‘(iv) sales directly to, or rebates, dis-
counts, or other price concessions provided 
to, pharmacy benefit managers, managed 
care organizations, health maintenance or-
ganizations, insurers, mail order phar-
macies that are not open to all members of 
the public, or long term care providers, 
provided that these rebates, discounts, or 
price concessions are not passed through to 
retail pharmacies; 
‘‘(v) sales directly to, or rebates, dis-
counts, or other price concessions provided 
to, hospitals, clinics, and physicians, unless 
the drug is an inhalation, infusion, or 
injectable drug, or unless the Secretary de-
termines, as allowed for in Agency admin-
istrative procedures, that it is necessary to 
include such sales, rebates, discounts, and 
price concessions in order to obtain an ac-
curate AMP for the drug. Such a deter-
mination shall not be subject to judicial re-
view; or 
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803 
‘‘(vi) rebates, discounts, and other 
price concessions required to be provided 
under agreements under subsections (f) 
and (g) of section 1860D–2(f).’’. 
(3) MANUFACTURER
REPORTING
REQUIRE-
MENTS.—Section 1927(b)(3) of such Act (42 U.S.C. 
1396r–8(b)(3)) is amended— 
(A) in subparagraph (A), by adding at the 
end the following new clause: 
‘‘(iv) not later than 30 days after the 
last day of each month of a rebate period 
under the agreement, on the manufactur-
er’s total number of units that are used to 
calculate the monthly average manufac-
turer price for each covered outpatient 
drug.’’. 
(4) AUTHORITY
TO
PROMULGATE
REGULA-
TION.—The Secretary of Health and Human Serv-
ices may promulgate regulations to clarify the re-
quirements for upper payment limits and for the de-
termination of the average manufacturer price in an 
expedited manner. Such regulations may become ef-
fective on an interim final basis, pending oppor-
tunity for public comment. 
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804 
(5) PHARMACY
REIMBURSEMENTS
THROUGH 
DECEMBER 31, 2010.—The specific upper limit under 
section 447.332 of title 42, Code of Federal Regula-
tions (as in effect on December 31, 2006) applicable 
to payments made by a State for multiple source 
drugs under a State Medicaid plan shall continue to 
apply through December 31, 2010, for purposes of 
the availability of Federal financial participation for 
such payments. 
(b) DISCLOSURE OF PRICE INFORMATION TO THE 
PUBLIC.—Section 1927(b)(3) of such Act (42 U.S.C. 
1396r–8(b)(3)) is amended— 
(1) in subparagraph (A)— 
(A) in clause (i), in the matter preceding 
subclause (I), by inserting ‘‘month of a’’ after 
‘‘each’’; and 
(B) in the last sentence, by striking ‘‘and 
shall,’’ and all that follows through the period; 
and 
(2) in subparagraph (D)(v), by inserting 
‘‘weighted’’ before ‘‘average manufacturer prices’’. 
SEC. 1742. PRESCRIPTION DRUG REBATES. 
(a) ADDITIONAL REBATE FOR NEW FORMULATIONS 
OF EXISTING DRUGS.— 
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(1) IN
GENERAL.—Section 1927(c)(2) of the 
Social Security Act (42 U.S.C. 1396r–8(c)(2)) is 
amended by adding at the end the following new 
subparagraph: 
‘‘(C) TREATMENT
OF
NEW
FORMULA-
TIONS.—In the case of a drug that is a line ex-
tension of a single source drug or an innovator 
multiple source drug that is an oral solid dos-
age form, the rebate obligation with respect to 
such drug under this section shall be the 
amount computed under this section for such 
new drug or, if greater, the product of— 
‘‘(i) the average manufacturer price of 
the line extension of a single source drug 
or an innovator multiple source drug that 
is an oral solid dosage form; 
‘‘(ii) the highest additional rebate 
(calculated as a percentage of average 
manufacturer price) under this section for 
any strength of the original single source 
drug or innovator multiple source drug; 
and 
‘‘(iii) the total number of units of 
each dosage form and strength of the line 
extension product paid for under the State 
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plan in the rebate period (as reported by 
the State). 
In this subparagraph, the term ‘line extension’ 
means, with respect to a drug, an extended re-
lease formulation of the drug.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to drugs dispensed 
after December 31, 2009. 
(b) INCREASE MINIMUM REBATE PERCENTAGE FOR 
SINGLE SOURCE DRUGS.—Section 1927(c)(1)(B)(i) of the 
Social Security Act (42 U.S.C. 1396r–8(c)(1)(B)(i)) is 
amended— 
(1) in subclause (IV), by striking ‘‘and’’ at the 
end; 
(2) in subclause (V)— 
(A) by inserting ‘‘and before January 1, 
2010’’ after ‘‘December 31, 1995,’’; and 
(B) by striking the period at the end and 
inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
clause: 
‘‘(VI) after December 31, 2009, 
is 22.1 percent.’’. 
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SEC. 1743. EXTENSION OF PRESCRIPTION DRUG DIS-
COUNTS TO ENROLLEES OF MEDICAID MAN-
AGED CARE ORGANIZATIONS. 
(a) IN GENERAL.—Section 1903(m)(2)(A) of the So-
cial Security Act (42 U.S.C. 1396b(m)(2)(A)) is amend-
ed— 
(1) in clause (xi), by striking ‘‘and’’ at the end; 
(2) in clause (xii), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(xiii) such contract provides that the entity 
shall report to the State such information, on such 
timely and periodic basis as specified by the Sec-
retary, as the State may require in order to include, 
in the information submitted by the State to a man-
ufacturer under section 1927(b)(2)(A), information 
on covered outpatient drugs dispensed to individuals 
eligible for medical assistance who are enrolled with 
the entity and for which the entity is responsible for 
coverage of such drugs under this subsection.’’. 
(b) CONFORMING AMENDMENTS.—Section 1927 of 
such Act (42 U.S.C. 1396r-8) is amended—— 
(1) in the first sentence of subsection (b)(1)(A), 
by inserting before the period at the end the fol-
lowing: ‘‘, including such drugs dispensed to individ-
uals enrolled with a medicaid managed care organi-
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zation if the organization is responsible for coverage 
of such drugs’’; 
(2) in subsection (b)(2), by adding at the end 
the following new subparagraph: 
‘‘(C) REPORTING ON MMCO DRUGS.—On a 
quarterly basis, each State shall report to the 
Secretary the total amount of rebates in dollars 
received from pharmacy manufacturers for 
drugs provided to individuals enrolled with 
Medicaid managed care organizations that con-
tract under section 1903(m).’’; and 
(3) in subsection (j)— 
(A) in the heading by striking ‘‘EXEMP-
TION’’ and inserting ‘‘SPECIAL RULES’’; and 
(B) in paragraph (1), by striking ‘‘not’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on July 1, 2010, and shall apply 
to drugs dispensed on or after such date, without regard 
to whether or not final regulations to carry out such 
amendments have been promulgated by such date. 
SEC. 1744. PAYMENTS FOR GRADUATE MEDICAL EDU-
CATION. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d), as amended by sections 
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1701(a)(2), 1711(a), and 1713(a), is amended by adding 
at the end the following new subsection: 
‘‘(bb) PAYMENT
FOR GRADUATE MEDICAL EDU-
CATION.— 
‘‘(1) IN GENERAL.—The term ‘medical assist-
ance’ includes payment for costs of graduate medical 
education consistent with this subsection, whether 
provided in or outside of a hospital. 
‘‘(2) SUBMISSION OF INFORMATION.—For pur-
poses 
of 
paragraph 
(1) 
and 
section 
1902(a)(13)(A)(v), payment for such costs is not 
consistent with this subsection unless— 
‘‘(A) the State submits to the Secretary, in 
a timely manner and on an annual basis speci-
fied by the Secretary, information on total pay-
ments for graduate medical education and how 
such payments are being used for graduate 
medical education, including— 
‘‘(i) the institutions and programs eli-
gible for receiving the funding; 
‘‘(ii) the manner in which such pay-
ments are calculated; 
‘‘(iii) the types and fields of education 
being supported; 
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‘‘(iv) the workforce or other goals to 
which the funding is being applied; 
‘‘(v) State progress in meeting such 
goals; and 
‘‘(vi) such other information as the 
Secretary determines will assist in carrying 
out paragraphs (3) and (4); and 
‘‘(B) such expenditures are made con-
sistent with such goals and requirements as are 
established under paragraph (4). 
‘‘(3) REVIEW OF INFORMATION.—The Secretary 
shall make the information submitted under para-
graph (2) available to the Advisory Committee on 
Health Workforce Evaluation and Assessment (es-
tablished under section 2261 of the Public Health 
Service Act). The Secretary and the Advisory Com-
mittee shall independently review the information 
submitted under paragraph (2), taking into account 
State and local workforce needs. 
‘‘(4) SPECIFICATION OF GOALS AND REQUIRE-
MENTS.—The Secretary shall specify by rule, ini-
tially published by not later than December 31, 
2011— 
‘‘(A) program goals for the use of funds 
described in paragraph (1), taking into account 
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recommendations of the such Advisory Com-
mittee and the goals for approved medical resi-
dency training programs described in section 
1886(h)(1)(B); and 
‘‘(B) requirements for use of such funds 
consistent with such goals. 
Such rule may be effective on an interim basis pend-
ing revision after an opportunity for public com-
ment.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1902(a)(13)(A) of such Act (42 U.S.C. 1396a(a)(13)(A)) 
is amended— 
(1) by striking ‘‘and’’ at the end of clause (iii); 
(2) by striking ‘‘; and’’ and inserting ‘‘, and’’; 
and 
(3) by adding at the end the following new 
clause: 
‘‘(v) in the case of hospitals and at 
the option of a State, such rates may in-
clude, to the extent consistent with section 
1905(bb), payment for graduate medical 
education; and’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of the enactment 
of this Act. Nothing in this section shall be construed as 
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affecting payments made before such date under a State 
plan under title XIX of the Social Security Act for grad-
uate medical education. 
Subtitle F—Waste, Fraud, and 
Abuse 
SEC. 1751. HEALTH-CARE ACQUIRED CONDITIONS. 
(a) MEDICAID NON-PAYMENT FOR CERTAIN HEALTH 
CARE-ACQUIRED CONDITIONS.—Section 1903(i) of the 
Social Security Act (42 U.S.C. 1396b(i)) is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(23); 
(2) by striking the period at the end of para-
graph (24) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (24) the fol-
lowing new paragraph: 
‘‘(25) with respect to amounts expended for 
services related to the presence of a condition that 
could be identified by a secondary diagnostic code 
described in section 1886(d)(4)(D)(iv) and for any 
health care acquired condition determined as a non- 
covered service under title XVIII.’’. 
(b) APPLICATION TO CHIP.—Section 2107(e)(1)(G) 
of such Act (42 U.S.C. 1397gg(e)(1)(G)) is amended by 
striking ‘‘and (17)’’ and inserting ‘‘(17), and (25)’’. 
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(c) PERMISSION TO INCLUDE ADDITIONAL HEALTH 
CARE-ACQUIRED CONDITIONS.—Nothing in this section 
shall prevent a State from including additional health 
care-acquired conditions for non-payment in its Medicaid 
program under title XIX of the Social Security Act. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to discharges occurring on or after 
January 1, 2010. 
SEC. 1752. EVALUATIONS AND REPORTS REQUIRED UNDER 
MEDICAID INTEGRITY PROGRAM. 
Section 1936(c)(2)) of the Social Security Act (42 
U.S.C. 1396u–7(c)(2)) is amended— 
(1) by redesignating subparagraph (D) as sub-
paragraph (E); and 
(2) by inserting after subparagraph (C) the fol-
lowing new subparagraph: 
‘‘(D) For the contract year beginning in 
2011 and each subsequent contract year, the 
entity provides assurances to the satisfaction of 
the Secretary that the entity will conduct peri-
odic evaluations of the effectiveness of the ac-
tivities carried out by such entity under the 
Program and will submit to the Secretary an 
annual report on such activities.’’. 
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SEC. 1753. REQUIRE PROVIDERS AND SUPPLIERS TO 
ADOPT 
PROGRAMS 
TO 
REDUCE 
WASTE, 
FRAUD, AND ABUSE. 
Section 1902(a) of such Act (42 U.S.C. 42 U.S.C. 
1396a(a)), as amended by sections 1631(b)(1) and 1703, 
is further amended— 
(1) in paragraph (74), by striking at the end 
‘‘and’’; 
(2) in paragraph (75), by striking at the end 
the period and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (75) the fol-
lowing new paragraph: 
‘‘(76) provide that any provider or supplier 
(other than a physician or nursing facility) providing 
services under such plan shall, subject to paragraph 
(5) of section 1874(d), establish a compliance pro-
gram described in paragraph (1) of such section in 
accordance with such section.’’. 
SEC. 1754. OVERPAYMENTS. 
(a) IN GENERAL.—Section 1903(d)(2)(C) of the So-
cial Security Act (42 U.S.C. 1396b(d)(2)(C)) is amended 
by inserting ‘‘(or 1 year in the case of overpayments due 
to fraud)’’ after ‘‘60 days’’. 
(b) EFFECTIVE DATE.—In the case overpayments 
discovered on or after the date of the enactment of this 
Act. 
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SEC. 1755. MANAGED CARE ORGANIZATIONS. 
(a) MINIMUM MEDICAL LOSS RATIO.— 
(1) MEDICAID.—Section 1903(m)(2)(A) of the 
Social Security Act (42 U.S.C. 1396b(m)(2)(A)), as 
amended by section 1743(a)(3), is amended— 
(A) by striking ‘‘and’’ at the end of clause 
(xii); 
(B) by striking the period at the end of 
clause (xiii) and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(xiv) such contract has a medical loss ratio, as 
determined in accordance with a methodology speci-
fied by the Secretary that is a percentage (not less 
than 85 percent) as specified by the Secretary.’’. 
(2) CHIP.—Section 2107(e)(1) of such Act (42 
U.S.C. 1397gg(e)(1)) is amended— 
(A) by redesignating subparagraphs (H) 
through (L) as subparagraphs (I) through (M); 
and 
(B) by inserting after subparagraph (G) 
the following new subparagraph: 
‘‘(H) Section 1903(m)(2)(A)(xiv) (relating 
to application of minimum loss ratios), with re-
spect to comparable contracts under this title.’’. 
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(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to contracts entered 
into or renewed on or after July 1, 2010. 
(b) PATIENT ENCOUNTER DATA.— 
(1) IN
GENERAL.—Section 1903(m)(2)(A)(xi) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(m)(2)(A)(xi)) is amended by inserting ‘‘and 
for the provision of such data to the State at a fre-
quency and level of detail to be specified by the Sec-
retary’’ after ‘‘patients’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply with respect to contract 
years beginning on or after January 1, 2010. 
SEC. 1756. TERMINATION OF PROVIDER PARTICIPATION 
UNDER MEDICAID AND CHIP IF TERMINATED 
UNDER MEDICARE OR OTHER STATE PLAN 
OR CHILD HEALTH PLAN. 
(a) 
STATE
PLAN
REQUIREMENT.—Section 
1902(a)(39) of the Social Security Act (42 U.S.C. 42 
U.S.C. 1396a(a)) is amended by inserting after ‘‘1128A,’’ 
the following: ‘‘terminate the participation of any indi-
vidual or entity in such program if (subject to such excep-
tions are permitted with respect to exclusion under sec-
tions 1128(b)(3)(C) and 1128(d)(3)(B)) participation of 
such individual or entity is terminated under title XVIII, 
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any other State plan under this title, or any child health 
plan under title XXI,’’. 
(b) APPLICATION TO CHIP.—Section 2107(e)(1)(A) 
of such Act (42 U.S.C. 1397gg(e)(1)(A)) is amended by 
inserting before the period at the end the following: ‘‘and 
section 1902(a)(39) (relating to exclusion and termination 
of participation)’’. 
(c) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to 
services furnished on or after January 1, 2011, 
without regard to whether or not final regulations to 
carry out such amendments have been promulgated 
by such date. 
(2) In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
or a child health plan under title XXI of such Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, the State plan or 
child health plan shall not be regarded as failing to 
comply with the requirements of such title solely on 
the basis of its failure to meet this additional re-
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quirement before the first day of the first calendar 
quarter beginning after the close of the first regular 
session of the State legislature that begins after the 
date of the enactment of this Act. For purposes of 
the previous sentence, in the case of a State that has 
a 2-year legislative session, each year of such session 
shall be deemed to be a separate regular session of 
the State legislature. 
SEC. 1757. MEDICAID AND CHIP EXCLUSION FROM PARTICI-
PATION RELATING TO CERTAIN OWNERSHIP, 
CONTROL, AND MANAGEMENT AFFILIATIONS. 
(a) STATE PLAN REQUIREMENT.—Section 1902(a) 
of the Social Security Act (42 U.S.C. 1396a(a)), as 
amended by sections 1631(b)(1), 1703, and 1753, is fur-
ther amended— 
(1) in paragraph (75), by striking at the end 
‘‘and’’; 
(2) in paragraph (76), by striking at the end 
the period and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (76) the fol-
lowing new paragraph: 
‘‘(77) provide that the State agency described 
in paragraph (9) exclude, with respect to a period, 
any individual or entity from participation in the 
program under the State plan if such individual or 
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entity owns, controls, or manages an entity that (or 
if such entity is owned, controlled, or managed by an 
individual or entity that)— 
‘‘(A) has unpaid overpayments under this 
title during such period determined by the Sec-
retary or the State agency to be delinquent; 
‘‘(B) is suspended or excluded from par-
ticipation under or whose participation is termi-
nated under this title during such period; or 
‘‘(C) is affiliated with an individual or enti-
ty that has been suspended or excluded from 
participation under this title or whose participa-
tion is terminated under this title during such 
period.’’. 
(b) CHILD HEALTH PLAN REQUIREMENT.—Section 
2107(e)(1)(A) of such Act (42 U.S.C. 1397gg(e)(1)(A)), 
as amended by section 1756(b), is amended by striking 
‘‘section 
1902(a)(39)’’ 
and 
inserting 
‘‘sections 
1902(a)(39) and 1902(a)(77)’’. 
(c) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to 
services furnished on or after January 1, 2011, 
without regard to whether or not final regulations to 
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carry out such amendments have been promulgated 
by such date. 
(2) In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
or a child health plan under title XXI of such Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, the State plan or 
child health plan shall not be regarded as failing to 
comply with the requirements of such title solely on 
the basis of its failure to meet this additional re-
quirement before the first day of the first calendar 
quarter beginning after the close of the first regular 
session of the State legislature that begins after the 
date of the enactment of this Act. For purposes of 
the previous sentence, in the case of a State that has 
a 2-year legislative session, each year of such session 
shall be deemed to be a separate regular session of 
the State legislature. 
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SEC. 1758. REQUIREMENT TO REPORT EXPANDED SET OF 
DATA ELEMENTS UNDER MMIS TO DETECT 
FRAUD AND ABUSE. 
Section 1903(r)(1)(F) of the Social Security Act (42 
U.S.C. 1396b(r)(1)(F)) is amended by inserting after 
‘‘necessary’’ the following: ‘‘and including, for data sub-
mitted to the Secretary on or after July 1, 2010, data 
elements from the automated data system that the Sec-
retary determines to be necessary for detection of waste, 
fraud, and abuse’’. 
SEC. 1759. BILLING AGENTS, CLEARINGHOUSES, OR OTHER 
ALTERNATE PAYEES REQUIRED TO REG-
ISTER UNDER MEDICAID. 
(a) IN GENERAL.—Section 1902(a) of the Social Se-
curity Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended 
by sections 1631(b), 1703, 1753, and 1757, is further 
amended— 
(1) in paragraph (76); by striking at the end 
‘‘and’’; 
(2) in paragraph (77), by striking the period at 
the end and inserting ‘‘and’’; and 
(3) by inserting after paragraph (77) the fol-
lowing new paragraph: 
‘‘(78) provide that any agent, clearinghouse, or 
other alternate payee that submits claims on behalf 
of a health care provider must register with the 
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State and the Secretary in a form and manner speci-
fied by the Secretary under section 1866(j)(1)(D).’’. 
(b) DENIAL OF PAYMENT.—Section 1903(i) of such 
Act (42 U.S.C. 1396b(i)), as amended by section 1753, 
is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(24); 
(2) by striking the period at the end of para-
graph (25) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (25) the fol-
lowing new paragraph: 
‘‘(26) with respect to any amount paid to a bill-
ing agent, clearinghouse, or other alternate payee 
that is not registered with the State and the Sec-
retary as required under section 1902(a)(78).’’. 
(c) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to 
claims submitted on or after January 1, 2012, with-
out regard to whether or not final regulations to 
carry out such amendments have been promulgated 
by such date. 
(2) In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
which the Secretary of Health and Human Services 
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determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, the State plan or 
child health plan shall not be regarded as failing to 
comply with the requirements of such title solely on 
the basis of its failure to meet this additional re-
quirement before the first day of the first calendar 
quarter beginning after the close of the first regular 
session of the State legislature that begins after the 
date of the enactment of this Act. For purposes of 
the previous sentence, in the case of a State that has 
a 2-year legislative session, each year of such session 
shall be deemed to be a separate regular session of 
the State legislature. 
SEC. 1760. DENIAL OF PAYMENTS FOR LITIGATION-RE-
LATED MISCONDUCT. 
(a) IN GENERAL.—Section 1903(i) of the Social Se-
curity Act (42 U.S.C. 1396b(i)), as previously amended 
is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(25); 
(2) by striking the period at the end of para-
graph (26) and inserting a semicolon; and 
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(3) by inserting after paragraph (26) the fol-
lowing new paragraphs: 
‘‘(27) with respect to any amount expended— 
‘‘(A) on litigation in which a court imposes 
sanctions on the State, its employees, or its 
counsel for litigation-related misconduct; or 
‘‘(B) to reimburse (or otherwise com-
pensate) a managed care entity for payment of 
legal expenses associated with any action in 
which a court imposes sanctions on the man-
aged care entity for litigation-related mis-
conduct.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to amounts expended on or after 
January 1, 2010. 
Subtitle G—Puerto Rico and the 
Territories 
SEC. 1771. PUERTO RICO AND TERRITORIES. 
(a) INCREASE IN CAP.— 
(1) IN GENERAL.—Section 1108(g) of the So-
cial Security Act (42 U.S.C. 1308(g)) is amended— 
(A) in paragraph (4) by striking ‘‘and (3)’’ 
and by inserting ‘‘(3), (6), and (7)’’; and 
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(B) by inserting after paragraph (5), as 
added by section 1731(d), the following new 
paragraph: 
‘‘(6) FISCAL YEARS 2011 THROUGH 2019.—The 
amounts otherwise determined under this subsection 
for Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, and American Samoa for 
fiscal year 2011 and each succeeding fiscal year 
through fiscal year 2019 shall be increased by the 
percentage specified under section 1771(c) of the 
America’s Affordable Health Choices Act of 2009 
for purposes of this paragraph of the amounts other-
wise determined under this section (without regard 
to this paragraph). 
‘‘(7) FISCAL YEAR 2020 AND SUBSEQUENT FIS-
CAL
YEARS.—The amounts otherwise determined 
under this subsection for Puerto Rico, the Virgin Is-
lands, Guam, the Northern Mariana Islands, and 
American Samoa for fiscal year 2020 and each suc-
ceeding fiscal year shall be the amount provided in 
paragraph (6) or this paragraph for the preceding 
fiscal year for the respective territory increased by 
the percentage increase referred to in paragraph 
(1)(B), rounded to the nearest $10,000 (or 
$100,000 in the case of Puerto Rico).’’. 
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(2) 
COORDINATION
WITH
ARRA.—Section 
5001(d) of the American Recovery and Reinvestment 
Act of 2009 shall not apply during any period for 
which section 1108(g)(6) of the Social Security Act, 
as added by paragraph (1), applies. 
(b) INCREASE IN FMAP.— 
(1) IN GENERAL.—Section 1905(b)(2) of the 
Social Security Act (42 U.S.C. 1396d(b)(2)) is 
amended by striking ‘‘50 per centum’’ and inserting 
‘‘for fiscal years 2011 through 2019, the percentage 
specified under section 1771(c) of the America’s Af-
fordable Health Choices Act of 2009 for purposes of 
this clause for such fiscal year and for subsequent 
fiscal years the percentage so specified for fiscal 
year 2019’’. 
(2) EFFECTIVE DATE.—The amendment made 
by subsection (a) shall apply to items and services 
furnished on or after October 1, 2010. 
(c) SPECIFICATION
OF PERCENTAGES.—The Sec-
retary of Health and Human Services shall specify, before 
January 1, 2011, the percentages to be applied under sec-
tion 1108(g)(6) of the Social Security Act, as added by 
subsection (a)(1), and under section 1905(b)(2) of such 
Act, as amended by subsection (b)(1), in a manner so that 
for the period beginning with 2011 and ending with 2019 
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the total estimated additional Federal expenditures result-
ing from the application of such percentages will be equal 
to $10,350,000,000. 
Subtitle H—Miscellaneous 
SEC. 1781. TECHNICAL CORRECTIONS. 
(a) TECHNICAL CORRECTION TO SECTION 1144 OF 
THE SOCIAL SECURITY ACT.—The first sentence of sec-
tion 1144(c)(3) of the Social Security Act (42 U.S.C. 
1320b—14(c)(3)) is amended— 
(1) by striking ‘‘transmittal’’; and 
(2) by inserting before the period the following: 
‘‘as specified in section 1935(a)(4)’’. 
(b) CLARIFYING AMENDMENT TO SECTION 1935 OF 
THE SOCIAL SECURITY ACT.—Section 1935(a)(4) of the 
Social Security Act (42 U.S.C. 1396u—5(a)(4)), as 
amended by section 113(b) of Public Law 110–275, is 
amended— 
(1) by striking the second sentence; 
(2) by redesignating the first sentence as a sub-
paragraph (A) with appropriate indentation and 
with the following heading: ‘‘IN GENERAL’’; 
(3) by adding at the end the following subpara-
graphs: 
‘‘(B) FURNISHING
MEDICAL
ASSISTANCE 
WITH
REASONABLE
PROMPTNESS.—For the 
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purpose of a State’s obligation under section 
1902(a)(8) to furnish medical assistance with 
reasonable promptness, the date of the elec-
tronic transmission of low-income subsidy pro-
gram data, as described in section 1144(c), 
from the Commissioner of Social Security to the 
State Medicaid Agency, shall constitute the date 
of filing of such application for benefits under 
the Medicare Savings Program. 
‘‘(C) 
DETERMINING
AVAILABILITY
OF 
MEDICAL ASSISTANCE.—For the purpose of de-
termining when medical assistance will be made 
available, the State shall consider the date of 
the individual’s application for the low income 
subsidy program to constitute the date of filing 
for benefits under the Medicare Savings Pro-
gram.’’. 
(c) EFFECTIVE
DATE
RELATING
TO
MEDICAID 
AGENCY CONSIDERATION OF LOW-INCOME SUBSIDY AP-
PLICATION AND DATA TRANSMITTAL.—The amendments 
made by subsections (a) and (b) shall be effective as if 
included in the enactment of section 113(b) of Public Law 
110–275. 
(d) TECHNICAL CORRECTION TO SECTION 605 OF 
CHIPRA.—Section 605 of the Children’s Health Insur-
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829 
ance Program Reauthorization Act of 2009 (Public Law 
111–3) is amended by striking ‘‘legal residents’’ and in-
serting ‘‘lawfully residing in the United States’’. 
(e) TECHNICAL CORRECTION TO SECTION 1905 OF 
THE SOCIAL SECURITY ACT.—Section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)) is amended by in-
serting ‘‘or the care and services themselves, or both’’ be-
fore ‘‘(if provided in or after’’. 
(f) CLARIFYING AMENDMENT TO SECTION 1115 OF 
THE SOCIAL SECURITY ACT.—Section 1115(a) of the So-
cial Security Act (42 U.S.C. 1315(a)) is amended by add-
ing at the end the following: ‘‘If an experimental, pilot, 
or demonstration project that relates to title XIX is ap-
proved pursuant to any part of this subsection, such 
project shall be treated as part of the State plan, all med-
ical assistance provided on behalf of any individuals af-
fected by such project shall be medical assistance provided 
under the State plan, and all provisions of this Act not 
explicitly waived in approving such project shall remain 
fully applicable to all individuals receiving benefits under 
the State plan.’’. 
SEC. 1782. EXTENSION OF QI PROGRAM. 
(a) IN GENERAL.—Section 1902(a)(10)(E)(iv) of the 
Social Security Act (42 U.S.C. 1396b(a)(10)(E)(iv)) is 
amended— 
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830 
(1) by striking ‘‘sections 1933 and’’ and by in-
serting ‘‘section’’; and 
(2) by striking ‘‘December 2010’’ and inserting 
‘‘December 2012’’. 
(b) ELIMINATION OF FUNDING LIMITATION.— 
(1) IN GENERAL.—Section 1933 of such Act 
(42 U.S.C. 1396u–3) is amended— 
(A) in subsection (a), by striking ‘‘who are 
selected to receive such assistance under sub-
section (b)’’; 
(B) by striking subsections (b), (c), (e), 
and (g); 
(C) in subsection (d), by striking ‘‘fur-
nished in a State’’ and all that follows and in-
serting ‘‘the Federal medical assistance percent-
age shall be equal to 100 percent.’’; and 
(D) by redesignating subsections (d) and 
(f) as subsections (b) and (c), respectively. 
(2) 
CONFORMING
AMENDMENT.—Section 
1905(b) of such Act (42 U.S.C. 1396d(b)) is amend-
ed by striking ‘‘1933(d)’’ and inserting ‘‘1933(b)’’. 
(3) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect on January 1, 
2011. 
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831 
TITLE VIII—REVENUE-RELATED 
PROVISIONS 
SEC. 1801. DISCLOSURES TO FACILITATE IDENTIFICATION 
OF INDIVIDUALS LIKELY TO BE INELIGIBLE 
FOR THE LOW-INCOME ASSISTANCE UNDER 
THE MEDICARE PRESCRIPTION DRUG PRO-
GRAM TO ASSIST SOCIAL SECURITY ADMINIS-
TRATION’S OUTREACH TO ELIGIBLE INDIVID-
UALS. 
(a) IN GENERAL.—Paragraph (19) of section 6103(l) 
of the Internal Revenue Code of 1986 is amended to read 
as follows: 
‘‘(19) DISCLOSURES
TO
FACILITATE
IDENTI-
FICATION
OF
INDIVIDUALS
LIKELY
TO
BE
INELI-
GIBLE FOR LOW-INCOME SUBSIDIES UNDER MEDI-
CARE PRESCRIPTION DRUG PROGRAM TO ASSIST SO-
CIAL
SECURITY
ADMINISTRATION’S
OUTREACH
TO 
ELIGIBLE INDIVIDUALS.— 
‘‘(A) IN GENERAL.—Upon written request 
from the Commissioner of Social Security, the 
following return information (including such in-
formation disclosed to the Social Security Ad-
ministration under paragraph (1) or (5)) shall 
be disclosed to officers and employees of the So-
cial Security Administration, with respect to 
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832 
any taxpayer identified by the Commissioner of 
Social Security— 
‘‘(i) return information for the appli-
cable year from returns with respect to 
wages (as defined in section 3121(a) or 
3401(a)) and payments of retirement in-
come (as described in paragraph (1) of this 
subsection), 
‘‘(ii) unearned income information 
and income information of the taxpayer 
from partnerships, trusts, estates, and sub-
chapter S corporations for the applicable 
year, 
‘‘(iii) if the individual filed an income 
tax return for the applicable year, the fil-
ing status, number of dependents, income 
from farming, and income from self-em-
ployment, on such return, 
‘‘(iv) if the individual is a married in-
dividual filing a separate return for the ap-
plicable year, the social security number (if 
reasonably available) of the spouse on such 
return, 
‘‘(v) if the individual files a joint re-
turn for the applicable year, the social se-
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833 
curity number, unearned income informa-
tion, and income information from partner-
ships, trusts, estates, and subchapter S 
corporations of the individual’s spouse on 
such return, and 
‘‘(vi) such other return information 
relating to the individual (or the individ-
ual’s spouse in the case of a joint return) 
as is prescribed by the Secretary by regula-
tion as might indicate that the individual 
is likely to be ineligible for a low-income 
prescription drug subsidy under section 
1860D–14 of the Social Security Act. 
‘‘(B) APPLICABLE
YEAR.—For the pur-
poses of this paragraph, the term ‘applicable 
year’ means the most recent taxable year for 
which information is available in the Internal 
Revenue Service’s taxpayer information records. 
‘‘(C) RESTRICTION ON INDIVIDUALS FOR 
WHOM DISCLOSURE MAY BE REQUESTED.—The 
Commissioner of Social Security shall request 
information under this paragraph only with re-
spect to— 
‘‘(i) individuals the Social Security 
Administration has identified, using all 
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834 
other reasonably available information, as 
likely to be eligible for a low-income pre-
scription 
drug 
subsidy 
under 
section 
1860D–14 of the Social Security Act and 
who have not applied for such subsidy, and 
‘‘(ii) any individual the Social Security 
Administration has identified as a spouse 
of an individual described in clause (i). 
‘‘(D) RESTRICTION ON USE OF DISCLOSED 
INFORMATION.—Return information disclosed 
under this paragraph may be used only by offi-
cers and employees of the Social Security Ad-
ministration solely for purposes of identifying 
individuals likely to be ineligible for a low-in-
come prescription drug subsidy under section 
1860D–14 of the Social Security Act for use in 
outreach efforts under section 1144 of the So-
cial Security Act.’’. 
(b) SAFEGUARDS.—Paragraph (4) of section 6103(p) 
of such Code is amended— 
(1) by striking ‘‘(19),’’ each place it appears, 
and 
(2) by striking ‘‘or (17)’’ each place it appears 
and inserting ‘‘(17), or (19)’’. 
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835 
(c) CONFORMING AMENDMENT.—Paragraph (3) of 
section 6103(a) of such Code is amended by striking 
‘‘(19),’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to disclosures made after the date 
which is 12 months after the date of the enactment of 
this Act. 
SEC. 
1802. 
COMPARATIVE 
EFFECTIVENESS 
RESEARCH 
TRUST FUND; FINANCING FOR TRUST FUND. 
(a) ESTABLISHMENT OF TRUST FUND.— 
(1) IN GENERAL.—Subchapter A of chapter 98 
of the Internal Revenue Code of 1986 (relating to 
trust fund code) is amended by adding at the end 
the following new section: 
‘‘SEC. 9511. HEALTH CARE COMPARATIVE EFFECTIVENESS 
RESEARCH TRUST FUND. 
‘‘(a) CREATION OF TRUST FUND.—There is estab-
lished in the Treasury of the United States a trust fund 
to be known as the ‘Health Care Comparative Effective-
ness Research Trust Fund’ (hereinafter in this section re-
ferred to as the ‘CERTF’), consisting of such amounts 
as may be appropriated or credited to such Trust Fund 
as provided in this section and section 9602(b). 
‘‘(b) TRANSFERS TO FUND.—There are hereby ap-
propriated to the Trust Fund the following: 
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836 
‘‘(1) For fiscal year 2010, $90,000,000. 
‘‘(2) For fiscal year 2011, $100,000,000. 
‘‘(3) For fiscal year 2012, $110,000,000. 
‘‘(4) For each fiscal year beginning with fiscal 
year 2013— 
‘‘(A) an amount equivalent to the net reve-
nues received in the Treasury from the fees im-
posed under subchapter B of chapter 34 (relat-
ing to fees on health insurance and self-insured 
plans) for such fiscal year; and 
‘‘(B) subject to subsection (c)(2), amounts 
determined by the Secretary of Health and 
Human Services to be equivalent to the fair 
share per capita amount computed under sub-
section (c)(1) for the fiscal year multiplied by 
the average number of individuals entitled to 
benefits under part A, or enrolled under part B, 
of title XVIII of the Social Security Act during 
such fiscal year. 
The amounts appropriated under paragraphs (1), (2), (3), 
and (4)(B) shall be transferred from the Federal Hospital 
Insurance Trust Fund and from the Federal Supple-
mentary Medical Insurance Trust Fund (established 
under section 1841 of such Act), and from the Medicare 
Prescription Drug Account within such Trust Fund, in 
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837 
proportion (as estimated by the Secretary) to the total ex-
penditures during such fiscal year that are made under 
title XVIII of such Act from the respective trust fund or 
account. 
‘‘(c) FAIR SHARE PER CAPITA AMOUNT.— 
‘‘(1) COMPUTATION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the fair share per capita amount 
under this paragraph for a fiscal year (begin-
ning with fiscal year 2013) is an amount com-
puted by the Secretary of Health and Human 
Services for such fiscal year that, when applied 
under this section and subchapter B of chapter 
34 of the Internal Revenue Code of 1986, will 
result 
in 
revenues 
to 
the 
CERTF 
of 
$375,000,000 for the fiscal year. 
‘‘(B) ALTERNATIVE COMPUTATION.— 
‘‘(i) IN GENERAL.—If the Secretary is 
unable to compute the fair share per capita 
amount under subparagraph (A) for a fis-
cal year, the fair share per capita amount 
under this paragraph for the fiscal year 
shall be the default amount determined 
under clause (ii) for the fiscal year. 
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838 
‘‘(ii) DEFAULT AMOUNT.—The default 
amount under this clause for— 
‘‘(I) fiscal year 2013 is equal to 
$2; or 
‘‘(II) a subsequent year is equal 
to the default amount under this 
clause for the preceding fiscal year in-
creased by the annual percentage in-
crease in the medical care component 
of the consumer price index (United 
States city average) for the 12-month 
period ending with April of the pre-
ceding fiscal year. 
Any amount determined under subclause 
(II) shall be rounded to the nearest penny. 
‘‘(2) LIMITATION ON MEDICARE FUNDING.—In 
no case shall the amount transferred under sub-
section (b)(4)(B) for any fiscal year exceed 
$90,000,000. 
‘‘(d) EXPENDITURES FROM FUND.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
amounts in the CERTF are available, without the 
need for further appropriations and without fiscal 
year limitation, to the Secretary of Health and 
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839 
Human Services for carrying out section 1181 of the 
Social Security Act. 
‘‘(2) ALLOCATION FOR COMMISSION.—Not less 
than the following amounts in the CERTF for a fis-
cal year shall be available to carry out the activities 
of the Comparative Effectiveness Research Commis-
sion established under section 1181(b) of the Social 
Security Act for such fiscal year: 
‘‘(A) For fiscal year 2010, $7,000,000. 
‘‘(B) For fiscal year 2011, $9,000,000. 
‘‘(C) For each fiscal year beginning with 
2012, $10,000,000. 
Nothing in this paragraph shall be construed as pre-
venting additional amounts in the CERTF from 
being made available to the Comparative Effective-
ness Research Commission for such activities. 
‘‘(e) NET REVENUES.—For purposes of this section, 
the term ‘net revenues’ means the amount estimated by 
the Secretary based on the excess of— 
‘‘(1) the fees received in the Treasury under 
subchapter B of chapter 34, over 
‘‘(2) the decrease in the tax imposed by chapter 
1 resulting from the fees imposed by such sub-
chapter.’’. 
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840 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for such subchapter A is amended by adding 
at the end thereof the following new item: 
‘‘Sec. 9511. Health Care Comparative Effectiveness Research Trust Fund.’’. 
(b) FINANCING FOR FUND FROM FEES ON INSURED 
AND SELF-INSURED HEALTH PLANS.— 
(1) GENERAL RULE.—Chapter 34 of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new subchapter: 
‘‘Subchapter B—Insured and Self-Insured 
Health Plans 
‘‘Sec. 4375. Health insurance. 
‘‘Sec. 4376. Self-insured health plans. 
‘‘Sec. 4377. Definitions and special rules. 
‘‘SEC. 4375. HEALTH INSURANCE. 
‘‘(a) IMPOSITION OF FEE.—There is hereby imposed 
on each specified health insurance policy for each policy 
year a fee equal to the fair share per capita amount deter-
mined under section 9511(c)(1) multiplied by the average 
number of lives covered under the policy. 
‘‘(b) LIABILITY FOR FEE.—The fee imposed by sub-
section (a) shall be paid by the issuer of the policy. 
‘‘(c) SPECIFIED HEALTH INSURANCE POLICY.—For 
purposes of this section: 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this section, the term ‘specified health in-
surance policy’ means any accident or health insur-
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841 
ance policy issued with respect to individuals resid-
ing in the United States. 
‘‘(2) EXEMPTION FOR CERTAIN POLICIES.—The 
term ‘specified health insurance policy’ does not in-
clude any insurance if substantially all of its cov-
erage is of excepted benefits described in section 
9832(c). 
‘‘(3) TREATMENT OF PREPAID HEALTH COV-
ERAGE ARRANGEMENTS.— 
‘‘(A) IN GENERAL.—In the case of any ar-
rangement described in subparagraph (B)— 
‘‘(i) such arrangement shall be treated 
as a specified health insurance policy, and 
‘‘(ii) the person referred to in such 
subparagraph shall be treated as the 
issuer. 
‘‘(B) DESCRIPTION OF ARRANGEMENTS.— 
An arrangement is described in this subpara-
graph if under such arrangement fixed pay-
ments or premiums are received as consider-
ation for any person’s agreement to provide or 
arrange for the provision of accident or health 
coverage to residents of the United States, re-
gardless of how such coverage is provided or ar-
ranged to be provided. 
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842 
‘‘SEC. 4376. SELF-INSURED HEALTH PLANS. 
‘‘(a) IMPOSITION OF FEE.—In the case of any appli-
cable self-insured health plan for each plan year, there is 
hereby imposed a fee equal to the fair share per capita 
amount determined under section 9511(c)(1) multiplied by 
the average number of lives covered under the plan. 
‘‘(b) LIABILITY FOR FEE.— 
‘‘(1) IN GENERAL.—The fee imposed by sub-
section (a) shall be paid by the plan sponsor. 
‘‘(2) PLAN SPONSOR.—For purposes of para-
graph (1) the term ‘plan sponsor’ means— 
‘‘(A) the employer in the case of a plan es-
tablished or maintained by a single employer, 
‘‘(B) the employee organization in the case 
of a plan established or maintained by an em-
ployee organization, 
‘‘(C) in the case of— 
‘‘(i) a plan established or maintained 
by 2 or more employers or jointly by 1 or 
more employers and 1 or more employee 
organizations, 
‘‘(ii) a multiple employer welfare ar-
rangement, or 
‘‘(iii) a voluntary employees’ bene-
ficiary association described in section 
501(c)(9), 
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843 
the association, committee, joint board of trust-
ees, or other similar group of representatives of 
the parties who establish or maintain the plan, 
or 
‘‘(D) the cooperative or association de-
scribed in subsection (c)(2)(F) in the case of a 
plan established or maintained by such a coop-
erative or association. 
‘‘(c) APPLICABLE SELF-INSURED HEALTH PLAN.— 
For purposes of this section, the term ‘applicable self-in-
sured health plan’ means any plan for providing accident 
or health coverage if— 
‘‘(1) any portion of such coverage is provided 
other than through an insurance policy, and 
‘‘(2) such plan is established or maintained— 
‘‘(A) by one or more employers for the 
benefit of their employees or former employees, 
‘‘(B) by one or more employee organiza-
tions for the benefit of their members or former 
members, 
‘‘(C) jointly by 1 or more employers and 1 
or more employee organizations for the benefit 
of employees or former employees, 
‘‘(D) by a voluntary employees’ beneficiary 
association described in section 501(c)(9), 
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‘‘(E) by any organization described in sec-
tion 501(c)(6), or 
‘‘(F) in the case of a plan not described in 
the preceding subparagraphs, by a multiple em-
ployer welfare arrangement (as defined in sec-
tion 3(40) of Employee Retirement Income Se-
curity 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). 
‘‘SEC. 4377. DEFINITIONS AND SPECIAL RULES. 
‘‘(a) DEFINITIONS.—For purposes of this sub-
chapter— 
‘‘(1) ACCIDENT AND HEALTH COVERAGE.—The 
term ‘accident and health coverage’ means any cov-
erage which, if provided by an insurance policy, 
would cause such policy to be a specified health in-
surance policy (as defined in section 4375(c)). 
‘‘(2) INSURANCE POLICY.—The term ‘insurance 
policy’ means any policy or other instrument where-
by a contract of insurance is issued, renewed, or ex-
tended. 
‘‘(3) UNITED
STATES.—The term ‘United 
States’ includes any possession of the United States. 
‘‘(b) TREATMENT OF GOVERNMENTAL ENTITIES.— 
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‘‘(1) IN GENERAL.—For purposes of this sub-
chapter— 
‘‘(A) the term ‘person’ includes any gov-
ernmental entity, and 
‘‘(B) notwithstanding any other law or rule 
of law, governmental entities shall not be ex-
empt from the fees imposed by this subchapter 
except as provided in paragraph (2). 
‘‘(2) TREATMENT OF EXEMPT GOVERNMENTAL 
PROGRAMS.—In the case of an exempt governmental 
program, no fee shall be imposed under section 4375 
or section 4376 on any covered life under such pro-
gram. 
‘‘(3) EXEMPT
GOVERNMENTAL
PROGRAM
DE-
FINED.—For purposes of this subchapter, the term 
‘exempt governmental program’ means— 
‘‘(A) any insurance program established 
under title XVIII of the Social Security Act, 
‘‘(B) the medical assistance program es-
tablished by title XIX or XXI of the Social Se-
curity Act, 
‘‘(C) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to individuals (or 
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the spouses and dependents thereof) by reason 
of such individuals being— 
‘‘(i) members of the Armed Forces of 
the United States, or 
‘‘(ii) veterans, and 
‘‘(D) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to members of In-
dian tribes (as defined in section 4(d) of the In-
dian Health Care Improvement Act). 
‘‘(c) TREATMENT AS TAX.—For purposes of subtitle 
F, the fees imposed by this subchapter shall be treated 
as if they were taxes. 
‘‘(d) NO COVER OVER TO POSSESSIONS.—Notwith-
standing any other provision of law, no amount collected 
under this subchapter shall be covered over to any posses-
sion of the United States.’’. 
(2) CLERICAL AMENDMENTS.— 
(A) Chapter 34 of such Code is amended 
by striking the chapter heading and inserting 
the following: 
‘‘CHAPTER 34—TAXES ON CERTAIN 
INSURANCE POLICIES 
‘‘SUBCHAPTER A. POLICIES ISSUED BY FOREIGN INSURERS 
‘‘SUBCHAPTER B. INSURED AND SELF-INSURED HEALTH PLANS 
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‘‘Subchapter A—Policies Issued By Foreign 
Insurers’’. 
(B) The table of chapters for subtitle D of 
such Code is amended by striking the item re-
lating to chapter 34 and inserting the following 
new item: 
‘‘CHAPTER 34—TAXES ON CERTAIN INSURANCE POLICIES’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to policies 
and plans for portions of policy or plan years begin-
ning on or after October 1, 2012. 
TITLE IX—MISCELLANEOUS 
PROVISIONS 
SEC. 1901. REPEAL OF TRIGGER PROVISION. 
Subtitle A of title VIII of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Pub-
lic Law 108–173) is repealed and the provisions of law 
amended by such subtitle are restored as if such subtitle 
had never been enacted. 
SEC. 1902. REPEAL OF COMPARATIVE COST ADJUSTMENT 
(CCA) PROGRAM. 
Section 1860C–1 of the Social Security Act (42 
U.S.C. 1395w–29), as added by section 241(a) of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173), is repealed. 
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SEC. 1903. EXTENSION OF GAINSHARING DEMONSTRATION. 
(a) IN GENERAL.—Subsection (d)(3) of section 5007 
of the Deficit Reduction Act of 2005 (Public Law 109– 
171) is amended by inserting ‘‘(or September 30, 2011, 
in the case of a demonstration project in operation as of 
October 1, 2008)’’ after ‘‘December 31, 2009’’. 
(b) FUNDING.— 
(1) IN
GENERAL.—Subsection (f)(1) of such 
section is amended by inserting ‘‘and for fiscal year 
2010, $1,600,000,’’ after ‘‘$6,000,000,’’. 
(2) AVAILABILITY.—Subsection (f)(2) of such 
section is amended by striking ‘‘2010’’ and inserting 
‘‘2014 or until expended’’. 
(c) REPORTS.— 
(1) QUALITY
IMPROVEMENT
AND
SAVINGS.— 
Subsection (e)(3) of such section is amended by 
striking ‘‘December 1, 2008’’ and inserting ‘‘March 
31, 2011’’. 
(2) FINAL REPORT.—Subsection (e)(4) of such 
section is amended by striking ‘‘May 1, 2010’’ and 
inserting ‘‘March 31, 2013’’. 
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849 
SEC. 1904. GRANTS TO STATES FOR QUALITY HOME VISITA-
TION PROGRAMS FOR FAMILIES WITH YOUNG 
CHILDREN AND FAMILIES EXPECTING CHIL-
DREN. 
Part B of title IV of the Social Security Act (42 
U.S.C. 621–629i) is amended by adding at the end the 
following: 
‘‘Subpart 3—Support for Quality Home Visitation 
Programs 
‘‘SEC. 440. HOME VISITATION PROGRAMS FOR FAMILIES 
WITH YOUNG CHILDREN AND FAMILIES EX-
PECTING CHILDREN. 
‘‘(a) PURPOSE.—The purpose of this section is to im-
prove the well-being, health, and development of children 
by enabling the establishment and expansion of high qual-
ity programs providing voluntary home visitation for fami-
lies with young children and families expecting children. 
‘‘(b) GRANT APPLICATION.—A State that desires to 
receive a grant under this section shall submit to the Sec-
retary for approval, at such time and in such manner as 
the Secretary may require, an application for the grant 
that includes the following: 
‘‘(1) DESCRIPTION OF HOME VISITATION PRO-
GRAMS.—A description of the high quality programs 
of home visitation for families with young children 
and families expecting children that will be sup-
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ported by a grant made to the State under this sec-
tion, the outcomes the programs are intended to 
achieve, and the evidence supporting the effective-
ness of the programs. 
‘‘(2) RESULTS OF NEEDS ASSESSMENT.—The 
results of a statewide needs assessment that de-
scribes— 
‘‘(A) the number, quality, and capacity of 
home visitation programs for families with 
young children and families expecting children 
in the State; 
‘‘(B) the number and types of families who 
are receiving services under the programs; 
‘‘(C) the sources and amount of funding 
provided to the programs; 
‘‘(D) the gaps in home visitation in the 
State, including identification of communities 
that are in high need of the services; and 
‘‘(E) training and technical assistance ac-
tivities designed to achieve or support the goals 
of the programs. 
‘‘(3) ASSURANCES.—Assurances from the State 
that— 
‘‘(A) in supporting home visitation pro-
grams using funds provided under this section, 
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851 
the State shall identify and prioritize serving 
communities that are in high need of such serv-
ices, especially communities with a high propor-
tion of low-income families or a high incidence 
of child maltreatment; 
‘‘(B) the State will reserve 5 percent of the 
grant funds for training and technical assist-
ance to the home visitation programs using 
such funds; 
‘‘(C) in supporting home visitation pro-
grams using funds provided under this section, 
the State will promote coordination and collabo-
ration with other home visitation programs (in-
cluding programs funded under title XIX) and 
with other child and family services, health 
services, income supports, and other related as-
sistance; 
‘‘(D) home visitation programs supported 
using such funds will, when appropriate, pro-
vide referrals to other programs serving chil-
dren and families; and 
‘‘(E) the State will comply with subsection 
(i), and cooperate with any evaluation con-
ducted under subsection (j). 
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852 
‘‘(4) OTHER INFORMATION.—Such other infor-
mation as the Secretary may require. 
‘‘(c) ALLOTMENTS.— 
‘‘(1) INDIAN
TRIBES.—From the amount re-
served under subsection (l)(2) for a fiscal year, the 
Secretary shall allot to each Indian tribe that meets 
the requirement of subsection (d), if applicable, for 
the fiscal year the amount that bears the same ratio 
to the amount so reserved as the number of children 
in the Indian tribe whose families have income that 
does not exceed 200 percent of the poverty line bears 
to the total number of children in such Indian tribes 
whose families have income that does not exceed 200 
percent of the poverty line. 
‘‘(2) STATES
AND
TERRITORIES.—From the 
amount appropriated under subsection (m) for a fis-
cal year that remains after making the reservations 
required by subsection (l), the Secretary shall allot 
to each State that is not an Indian tribe and that 
meets the requirement of subsection (d), if applica-
ble, for the fiscal year the amount that bears the 
same ratio to the remainder of the amount so appro-
priated as the number of children in the State whose 
families have income that does not exceed 200 per-
cent of the poverty line bears to the total number of 
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children in such States whose families have income 
that does not exceed 200 percent of the poverty line. 
‘‘(3) REALLOTMENTS.—The amount of any al-
lotment to a State under a paragraph of this sub-
section for any fiscal year that the State certifies to 
the Secretary will not be expended by the State pur-
suant to this section shall be available for reallot-
ment using the allotment methodology specified in 
that paragraph. Any amount so reallotted to a State 
is deemed part of the allotment of the State under 
this subsection. 
‘‘(d) MAINTENANCE OF EFFORT.—Beginning with 
fiscal year 2011, a State meets the requirement of this 
subsection for a fiscal year if the Secretary finds that the 
aggregate expenditures by the State from State and local 
sources for programs of home visitation for families with 
young children and families expecting children for the then 
preceding fiscal year was not less than 100 percent of such 
aggregate expenditures for the then 2nd preceding fiscal 
year. 
‘‘(e) PAYMENT OF GRANT.— 
‘‘(1) IN GENERAL.—The Secretary shall make a 
grant to each State that meets the requirements of 
subsections (b) and (d), if applicable, for a fiscal 
year for which funds are appropriated under sub-
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854 
section (m), in an amount equal to the reimbursable 
percentage of the eligible expenditures of the State 
for the fiscal year, but not more than the amount 
allotted to the State under subsection (c) for the fis-
cal year. 
‘‘(2) REIMBURSABLE PERCENTAGE DEFINED.— 
In paragraph (1), the term ‘reimbursable percent-
age’ means, with respect to a fiscal year— 
‘‘(A) 85 percent, in the case of fiscal year 
2010; 
‘‘(B) 80 percent, in the case of fiscal year 
2011; or 
‘‘(C) 75 percent, in the case of fiscal year 
2012 and any succeeding fiscal year. 
‘‘(f) ELIGIBLE EXPENDITURES.— 
‘‘(1) IN GENERAL.—In this section, the term 
‘eligible expenditures’— 
‘‘(A) means expenditures to provide vol-
untary home visitation for as many families 
with young children (under the age of school 
entry) and families expecting children as prac-
ticable, through the implementation or expan-
sion of high quality home visitation programs 
that— 
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‘‘(i) adhere to clear evidence-based 
models of home visitation that have dem-
onstrated positive effects on important pro-
gram-determined child and parenting out-
comes, such as reducing abuse and neglect 
and improving child health and develop-
ment; 
‘‘(ii) employ well-trained and com-
petent staff, maintain high quality super-
vision, provide for ongoing training and 
professional development, and show strong 
organizational capacity to implement such 
a program; 
‘‘(iii) establish appropriate linkages 
and referrals to other community resources 
and supports; 
‘‘(iv) monitor fidelity of program im-
plementation to ensure that services are 
delivered according to the specified model; 
and 
‘‘(v) provide parents with— 
‘‘(I) knowledge of age-appro-
priate child development in cognitive, 
language, social, emotional, and motor 
domains (including knowledge of sec-
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vance their careers, and to otherwise carry out the pur-
poses of this section. 
(c) ELIGIBILITY.—To be eligible for a grant under 
this section, an entity shall be— 
(1) a health care entity that is jointly adminis-
tered by a health care employer and a labor union 
representing the health care employees of the em-
ployer and that carries out activities using labor 
management training funds as provided for under 
section 302(c)(6) of the Labor Management Rela-
tions Act, 1947 (29 U.S.C. 186(c)(6)); 
(2) an entity that operates a training program 
that is jointly administered by— 
(A) one or more health care providers or 
facilities, or a trade association of health care 
providers; and 
(B) one or more organizations which rep-
resent the interests of direct care health care 
workers or staff nurses and in which the direct 
care health care workers or staff nurses have 
direct input as to the leadership of the organi-
zation; 
(3) a State training partnership program that 
consists of nonprofit organizations that include equal 
participation from industry, including public or pri-
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1934 
‘‘(1) IN GENERAL.—The Secretary shall make 
grants to, or enter into contracts with, eligible enti-
ties— 
‘‘(A) to plan, develop, operate, or partici-
pate in an accredited professional training pro-
gram, including an accredited residency or in-
ternship program, in the field of family medi-
cine, general internal medicine, general pediat-
rics, or geriatrics for medical students, interns, 
residents, or practicing physicians; 
‘‘(B) to provide financial assistance in the 
form of traineeships and fellowships to medical 
students, interns, residents, or practicing physi-
cians, who are participants in any such pro-
gram, and who plan to specialize or work in 
family medicine, general internal medicine, gen-
eral pediatrics, or geriatrics; 
‘‘(C) to plan, develop, operate, or partici-
pate in an accredited program for the training 
of physicians who plan to teach in family medi-
cine, general internal medicine, general pediat-
rics, or geriatrics training programs including 
in community-based settings; 
‘‘(D) to provide financial assistance in the 
form of traineeships and fellowships to prac-
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any member to serve more than a total of 6 
years. 
‘‘(B) 
STAGGERED
TERMS.—Notwith-
standing subparagraph (A), of the members 
first appointed to the Advisory Committee 
under paragraph (1)— 
‘‘(i) 5 shall be appointed for a term of 
1 year; 
‘‘(ii) 5 shall be appointed for a term 
of 2 years; and 
‘‘(iii) 5 shall be appointed for a term 
of 3 years. 
‘‘(3) QUALIFICATIONS.—Members of the Advi-
sory Committee shall be appointed from among indi-
viduals who possess expertise in at least one of the 
following areas: 
‘‘(A) Conducting and interpreting health 
workforce market analysis, including health 
care labor workforce analysis. 
‘‘(B) Conducting and interpreting health 
finance and economics research. 
‘‘(C) Delivering and administering health 
care services. 
‘‘(D) Delivering and administering health 
workforce education and training. 
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