[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1679 Placed on Calendar Senate (PCS)]

                                                       Calendar No. 161
111th CONGRESS
  1st Session
                                S. 1679

  To make quality, affordable health care available to all Americans, 
reduce costs, improve health care quality, enhance disease prevention, 
               and strengthen the health care workforce.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 17, 2009

    Mr. Harkin, from the Committee on Health, Education, Labor, and 
Pensions reported the following original bill; which was read twice and 
                         placed on the calendar

_______________________________________________________________________

                                 A BILL


 
  To make quality, affordable health care available to all Americans, 
reduce costs, improve health care quality, enhance disease prevention, 
               and strengthen the health care workforce.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Affordable Health 
Choices Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
       TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

            Subtitle A--Effective Coverage for All Americans

   PART I--Provisions Applicable to the Individual and Group Markets

Sec. 101. Amendment to the Public Health Service Act.
             ``PART A--Individual and Group Market Reforms

                      ``subpart 1--general reform

        ``Sec. 2705. Prohibition of preexisting condition exclusions or 
                            other discrimination based on health 
                            status.
        ``Sec. 2701. Fair insurance coverage.
        ``Sec. 2702. Guaranteed availability of coverage.
        ``Sec. 2703. Guaranteed renewability of coverage.
        ``Sec. 2704. Increasing the Transparency of Health Care Costs 
                            and Regulatory Fees.
        ``Sec. 2706. Prohibiting discrimination against individual 
                            participants and beneficiaries based on 
                            health status.
        ``Sec. 2707. Ensuring the quality of care.
        ``Sec. 2708. Coverage of preventive health services.
        ``Sec. 2709. Coverage of Preventive Women's Health Services.
        ``Sec. 2710. Extension of dependent coverage.
        ``Sec. 2711. No lifetime or annual limits.
        ``Sec. 2712. Notification by plans not providing minimum 
                            qualifying coverage.
        ``Sec. 2713. Non-discrimination in health care.
           PART II--Provision Applicable to the Group Market

Sec. 121. Amendment to the Public Health Service Act.
        ``Sec. 2720A. Prohibition of discrimination based on salary.
                       PART III--Other Provisions

Sec. 131. No changes to existing coverage.
Sec. 132. Applicability.
Sec. 133. Conforming amendments.
Sec. 134. Savings.
Sec. 135. Effective dates.
            Subtitle B--Available Coverage for All Americans

Sec. 141. Building on the success of the Federal Employees Health 
                            Benefits Program and the health benefits 
                            program of most large employers so all 
                            Americans have affordable health benefit 
                            choices.
Sec. 142. Affordable health choices for all Americans.
       ``TITLE XXXI--AFFORDABLE HEALTH CHOICES FOR ALL AMERICANS

                    ``Subtitle A--Affordable Choices

        ``Sec. 3101. Affordable choices of health benefit plans.
        ``Sec. 3102. Financial integrity.
        ``Sec. 3103. Program design.
        ``Sec. 3104. Allowing State flexibility.
        ``Sec. 3105. Navigators.
        ``Sec. 3106. Community health insurance option.
        ``Sec. 3107. Application of same laws to private plans and the 
                            community health insurance option.
        ``Sec. 3108. Participation of professionals on certain health-
                            related commissions.
        ``Sec. 3109. Health insurance consumer assistance grants.
Sec. 143. Freedom not to participate in Federal health insurance 
                            programs.
           Subtitle C--Affordable Coverage for All Americans

Sec. 151. Support for affordable health coverage.
                ``Subtitle B--Making Coverage Affordable

        ``Sec. 3111. Support for affordable health coverage.
        ``Sec. 3112. Small business health options program credit.
Sec. 152. Program integrity.
           Subtitle D--Shared Responsibility for Health Care

Sec. 161. Individual responsibility.
Sec. 162. Notification on the availability of affordable health 
                            choices.
Sec. 163. Shared responsibility of employers.
        ``Sec. 3115. Shared responsibility of employers.
        ``Sec. 3116. Definitions.
          Subtitle E--Improving Access to Health Care Services

Sec. 171. Spending for Federally Qualified Health Centers (FQHCs).
Sec. 172. Other provisions.
Sec. 173. Negotiated rulemaking for development of methodology and 
                            criteria for designating medically 
                            underserved populations and health 
                            professions shortage areas.
Sec. 174. Equity for certain eligible survivors.
Sec. 175. Reauthorization of the Wakefield Emergency Medical Services 
                            for Children Program.
Sec. 176. Co-locating primary and specialty care in community-based 
                            mental health settings.
      Subtitle F--Making Health Care More Affordable for Retirees

Sec. 181. Reinsurance for retirees.
  Subtitle G--Improving the Use of Health Information Technology for 
                  Enrollment; Miscellaneous Provisions

Sec. 185. Health information technology enrollment standards and 
                            protocols.
Sec. 186. Rule of construction regarding Hawaii's Prepaid Health Care 
                            Act.
Sec. 187. Key National indicators.
Sec. 188. Study and report on rates of preventable diseases in new 
                            Medicare enrollees.
Sec. 189. Transparency in government.
Sec. 189A. Preserving the solvency of Medicare and Social Security.
Sec. 189B. Prohibition against discrimination on assisted suicide.
Sec. 189C. Access to therapies.
Sec. 189D. Freedom not to participate in Federal health insurance 
                            programs.
                         Subtitle H--CLASS Act

Sec. 190. Short title of subtitle.
Sec. 191. Establishment of national voluntary insurance program for 
                            purchasing community living assistance 
                            services and support.
    ``TITLE XXXII--COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS

        ``Sec. 3201. Purpose.
        ``Sec. 3202. Definitions.
        ``Sec. 3203. CLASS Independence Benefit Plan.
        ``Sec. 3204. Enrollment and disenrollment requirements.
        ``Sec. 3205. Benefits.
        ``Sec. 3206. CLASS Independence Fund.
        ``Sec. 3207. CLASS Independence Advisory Council.
        ``Sec. 3208. Regulations; annual report.
        ``Sec. 3209. Inspector General's report.
        ``Sec. 3210. Tax treatment of program.
     TITLE II--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE

      Subtitle A--National Strategy to Improve Health Care Quality

Sec. 201. National strategy.
Sec. 202. Interagency Working Group on Health Care Quality.
Sec. 203. Quality measure development.
Sec. 204. Quality measure endorsement; public reporting; data 
                            collection.
Sec. 205. Collection and analysis of data for quality and resource use 
                            measures.
              Subtitle B--Health Care Quality Improvements

Sec. 211. Health care delivery system research; Quality improvement 
                            technical assistance.
Sec. 212. Grants to establish community health teams to support the 
                            patient-centered medical home.
Sec. 213. Grants to implement medication management services in 
                            treatment of chronic disease.
Sec. 214. Design and implementation of regionalized systems for 
                            emergency care.
Sec. 215. Trauma care centers and service availability.
Sec. 216. Reducing and reporting hospital readmissions.
Sec. 217. Program to facilitate shared decisionmaking.
Sec. 218. Presentation of prescription drug benefit and risk 
                            information.
Sec. 219. Center for health outcomes research and evaluation.
Sec. 220. Demonstration program to integrate quality improvement and 
                            patient safety training into clinical 
                            education of health professionals.
Sec. 221. Office of women's health.
Sec. 222. Administrative simplification.
Sec. 223. Patient navigator program.
Sec. 224. Authorization of appropriations.
  Subtitle C--Civil and Criminal Penalties for Acts Involving Federal 
  Health Care Programs; Exception to Limitation on Certain Physician 
                               Referrals

Sec. 231. Safe harbors to antikickback civil penalties and criminal 
                            penalties for provision of health 
                            information technology and training 
                            services.
Sec. 232. Exception to limitation on certain physician referrals (under 
                            Stark) for provision of health information 
                            technology and training services to health 
                            care professionals.
Sec. 233. Rules of construction regarding use of consortia.
         TITLE III--IMPROVING THE HEALTH OF THE AMERICAN PEOPLE

  Subtitle A--Modernizing Disease Prevention and Public Health Systems

Sec. 301. National Prevention, Health Promotion and Public Health 
                            Council.
Sec. 302. Prevention and Public Health Fund.
Sec. 303. Clinical and Community Preventive Services.
Sec. 304. Education and outreach campaign regarding preventive 
                            benefits.
     Subtitle B--Increasing Access to Clinical Preventive Services

Sec. 311. Right choices program.
Sec. 312. School-based health clinics.
Sec. 313. Oral healthcare prevention activities.
Sec. 314. Oral health improvement.
               Subtitle C--Creating Healthier Communities

Sec. 321. Community transformation grants.
Sec. 322. Healthy aging, living well.
Sec. 323. Wellness for individuals with disabilities.
Sec. 324. Immunizations.
Sec. 325. Nutrition labeling of standard menu items at chain 
                            restaurants and of articles of food sold 
                            from vending machines.
Sec. 326. Encouraging employer-sponsored wellness programs.
Sec. 327. Demonstration project concerning individualized wellness 
                            plan.
Sec. 328. Reasonable break time for nursing mothers.
    Subtitle D--Support for Prevention and Public Health Innovation

Sec. 331. Research on optimizing the delivery of public health 
                            services.
Sec. 332. Understanding health disparities: data collection and 
                            analysis.
Sec. 333. Health impact assessments.
Sec. 334. CDC and employer-based wellness programs.
Sec. 335. Epidemiology-Laboratory Capacity Grants.
Sec. 336. Federal messaging on health promotion and disease prevention.
 Subtitle E--Advancing Research and Treatment for Pain Care Management

Sec. 341. Institute of Medicine Conference on Pain.
Sec. 342. Pain research at National Institutes of Health.
Sec. 343. Pain care education and training.
Sec. 344. Public awareness campaign on pain management.
      Subtitle F--Coordinated Environmental Public Health Network

Sec. 351. Amendment to the Public Health Service Act.
                  Subtitle G--Miscellaneous Provisions

Sec. 361. Sense of the Senate concerning CBO scoring.
Sec. 362. Effectiveness of Federal health and wellness initiatives.
                    TITLE IV--HEALTH CARE WORKFORCE

                  Subtitle A--Purpose and Definitions

Sec. 401. Purpose.
Sec. 402. Definitions.
          Subtitle B--Innovations in the Health Care Workforce

Sec. 411. National health care workforce commission.
Sec. 412. State health care workforce development grants.
Sec. 413. Health care workforce program assessment.
     Subtitle C--Increasing the Supply of the Health Care Workforce

Sec. 421. Federally supported student loan funds.
Sec. 422. Nursing student loan program.
Sec. 423. Health care workforce loan repayment programs.
Sec. 424. Public health workforce recruitment and retention programs.
Sec. 425. Allied health workforce recruitment and retention programs.
Sec. 426. Grants for State and local programs.
Sec. 427. Funding for National Health Service Corps.
Sec. 428. Nurse-managed health clinics.
Sec. 429. Elimination of cap on commissioned corps.
Sec. 430. Establishing a Ready Reserve Corps.
   Subtitle D--Enhancing Health Care Workforce Education and Training

Sec. 431. Training in family medicine, general internal medicine, 
                            general pediatrics, and physician 
                            assistantship.
Sec. 432. Training opportunities for direct care workers.
Sec. 433. Training in general, pediatric, and public health dentistry.
Sec. 434. Alternative dental health care providers demonstration 
                            project.
Sec. 435. Geriatric education and training; career awards; 
                            comprehensive geriatric education.
Sec. 436. Mental and behavioral health education and training grants.
Sec. 437. Cultural competency, prevention and public health and 
                            individuals with disabilities training.
Sec. 438. Advanced nursing education grants.
Sec. 439. Nurse education, practice, and retention grants.
Sec. 440. Loan repayment and scholarship program.
Sec. 441. Nurse faculty loan program.
Sec. 442. Authorization of appropriations for parts B through D of 
                            title VIII.
Sec. 443. Grants to promote the community health workforce.
Sec. 444. Youth public health program.
Sec. 445. Fellowship training in public health.
Sec. 446. United States Public Health Sciences Track.
       Subtitle E--Supporting the Existing Health Care Workforce

Sec. 451. Centers of excellence.
Sec. 452. Health care professionals training for diversity.
Sec. 453. Interdisciplinary, community-based linkages.
Sec. 454. Workforce diversity grants.
Sec. 455. Primary care extension program.
Sec. 456. Definition of economic hardship.
                     Subtitle F--General Provisions

Sec. 461. Reports.
                  TITLE V--PREVENTING FRAUD AND ABUSE

    Subtitle A--Establishment of New Health and Human Services and 
           Department of Justice Health Care Fraud Positions

Sec. 501. Health and Human Services Senior Advisor.
Sec. 502. Department of Justice Position.
Sec. 503. Reports to Congress.
Sec. 504. Fraud, waste, and abuse commission.
     Subtitle B--Health Care Program Integrity Coordinating Council

Sec. 511. Establishment.
            Subtitle C--False Statements and Representations

Sec. 521. Prohibition on false statements and representations.
                Subtitle D--Federal Health Care Offense

Sec. 531. Clarifying definition.
          Subtitle E--Uniformity in Fraud and Abuse Reporting

Sec. 541. Development of model uniform report form.
    Subtitle F--Applicability of State Law to Combat Fraud and Abuse

Sec. 551. Applicability of State law to combat fraud and abuse.
 Subtitle G--Enabling the Department of Labor to Issue Administrative 
  Summary Cease and Desist Orders and Summary Seizures Orders Against 
           Plans That Are in Financially Hazardous Condition

Sec. 561. Enabling the Department of Labor to issue administrative 
                            summary cease and desist orders and summary 
                            seizures orders against plans that are in 
                            financially hazardous condition.
  Subtitle H--Requiring Multiple Employer Welfare Arrangement (MEWA) 
Plans to File a Registration Form With the Department of Labor Prior to 
                      Enrolling Anyone in the Plan

Sec. 571. MEWA plan registration with Department of Labor.
     Subtitle I--Permitting Evidentiary Privilege and Confidential 
                             Communications

Sec. 581. Permitting evidentiary privilege and confidential 
                            communications.
       TITLE VI--IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES

         Subtitle A--Biologics Price Competition and Innovation

Sec. 601. Short title.
Sec. 602. Approval pathway for biosimilar biological products.
Sec. 603. Savings.
  Subtitle B--More Affordable Medicines for Children and Underserved 
                              Communities

Sec. 611. Expanded participation in 340B program.
Sec. 612. Improvements to 340B program integrity.
Sec. 613. GAO study to make recommendations on improving the 340B 
                            program.

       TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

            Subtitle A--Effective Coverage for All Americans

   PART I--PROVISIONS APPLICABLE TO THE INDIVIDUAL AND GROUP MARKETS

SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    Part A of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg et seq.) is amended--
            (1) by striking the part heading and heading for subpart 1 
        and inserting the following:

             ``PART A--INDIVIDUAL AND GROUP MARKET REFORMS

                     ``Subpart 1--General Reform'';

            (2) in section 2701 (42 U.S.C. 300gg)--
                    (A) by striking the section heading and subsection 
                (a) and inserting the following:

``SEC. 2705. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER 
              DISCRIMINATION BASED ON HEALTH STATUS.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may not 
impose any preexisting condition exclusion with respect to such plan or 
coverage.''; and
                    (B) by transferring the remainder of section so as 
                to appear after the section 2704 as added by paragraph 
                (5);
            (3) in section 2702 (42 U.S.C. 300gg-1)--
                    (A) by striking the section heading and all that 
                follows through subsection (a)--
                    (B) in subsection (b)--
                            (i) by striking ``health insurance issuer 
                        offering health insurance coverage in 
                        connection with a group health plan'' each 
                        place that such appears and inserting ``health 
                        insurance issuer offering group or individual 
                        health insurance coverage''; and
                            (ii) in paragraph (2)(A)--
                                    (I) by inserting ``or individual'' 
                                after ``employer''; and
                                    (II) by inserting ``or individual 
                                health coverage, as the case may be'' 
                                before the semicolon;
                    (C) by redesignating subsections (b) through (f) as 
                subsections (e) through (i), respectively; and
                    (D) by transferring the remainder of such section 
                to appear at the end of section 2706 (as added by 
                paragraph (5));
            (4) by redesignating existing sections 2704 through 2707 
        and sections 2711 through 2713 as sections 2717 through 2720 
        and sections 2714 through 2716, respectively; and
            (5) by inserting after the subpart heading (as added by 
        paragraph (1)) the following:

``SEC. 2701. FAIR INSURANCE COVERAGE.

    ``(a) In General.--With respect to the premium rate charged by a 
health insurance issuer for health insurance coverage offered in the 
individual or small group market--
            ``(1) such rate shall vary with respect to the particular 
        plan or coverage involved only by--
                    ``(A) family structure;
                    ``(B) community rating area;
                    ``(C) the actuarial value of the benefit;
                    ``(D) age, except that such rate shall not vary by 
                more than 2 to 1;
                    ``(E) tobacco use, except that such rate shall not 
                vary by more than 1.5 to 1; and
                    ``(F) adherence to or participation in a reasonably 
                designed program of health promotion and disease 
                prevention, if such a program is offered by the 
                employer that is the sponsor of the coverage involved; 
                and
            ``(2) such rate shall not vary with respect to the 
        particular plan or coverage involved by health status-related 
        factors, gender, class of business, claims experience, 
        industry, or any other factor not described in paragraph (1), 
        except that group health plans and health insurance issuers 
        offering group health insurance coverage may establish premium 
        discounts or rebates for modifying otherwise applicable 
        copayments or deductibles in return for adherence to or 
        participation in reasonably designed programs of health 
        promotion or disease prevention.
    ``(b) Community Rating Area.--Taking into account the applicable 
recommendations of the National Association of Insurance Commissioners, 
the Secretary shall by regulation establish a minimum size for 
community rating areas for purposes of this section, which, for areas 
contained in a Metropolitan Statistical Area, shall not be smaller than 
such area.

``SEC. 2702. GUARANTEED AVAILABILITY OF COVERAGE.

    ``(a) Issuance of Coverage in the Individual and Group Market.--
Subject to subsections (b) through (e), each health insurance issuer 
that offers health insurance coverage in the individual or group market 
in a State must accept every employer and individual in the State that 
applies for such coverage.
    ``(b) Enrollment.--
            ``(1) Restriction.--A health insurance issuer described in 
        subsection (a) may restrict enrollment in coverage described in 
        such subsection to open or special enrollment periods.
            ``(2) Establishment.--A health insurance issuer described 
        in subsection (a) shall, in accordance with the regulations 
        promulgated under paragraph (3), establish special enrollment 
        periods for qualifying events (under section 603 of the 
        Employee Retirement Income Security Act of 1974).
            ``(3) Regulations.--Not later than 1 year after the date of 
        enactment of this section, the Secretary shall promulgate 
        regulations with respect to enrollment periods under paragraphs 
        (1) and (2).

``SEC. 2703. GUARANTEED RENEWABILITY OF COVERAGE.

    ``(a) In General.--Except as provided in this section, if a health 
insurance issuer offers health insurance coverage in the individual or 
group market, the issuer must renew or continue in force such coverage 
at the option of the plan sponsor or the individual, as applicable.
    ``(b) Prohibition on Rescissions.--A group health plan and a health 
insurance issuer offering group or individual health insurance coverage 
shall not rescind such coverage once the plan involved has been issued, 
except that this subsection shall not apply to a covered individual who 
has performed an act or practice that constitutes fraud or makes an 
intentional misrepresentation of material fact as prohibited by the 
terms of the coverage. Coverage may not be cancelled except with prior 
notice to the enrollee, and only as permitted under section 2702(c) or 
2742(b).

``SEC. 2704. INCREASING THE TRANSPARENCY OF HEALTH CARE COSTS AND 
              REGULATORY FEES.

    ``(a) Clear Accounting for Costs.--A health insurance issuer 
offering group or individual health insurance coverage shall publicly 
report (in a manner to be established by the Secretary through 
regulation) the percentage of total premium revenue that such coverage 
expends--
            ``(1) on reimbursement for clinical services provided to 
        enrollees under such plan or coverage;
            ``(2) for activities that improve health care quality;
            ``(3) on taxes, license, or regulatory fee costs, and the 
        cost of any surcharge imposed by the Gateway under title XXXI; 
        and
            ``(4) on all other non-claims costs, including an 
        explanation of the nature of such costs and an itemized list of 
        costs associated with compliance with the Affordable Health 
        Choices Act.
    ``(b) Definition.--In this section, the term `activities to improve 
health care quality' means activities described in section 2707.
    ``(c) Processes and Methods.--The Secretary shall develop a 
methodology for calculating the percentages described in subsection 
(a). Such methodology may provide for a requirement that a report 
described in subsection (a) include an actuarial certification of the 
information included in such report.

``SEC. 2706. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS 
              AND BENEFICIARIES BASED ON HEALTH STATUS.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may not 
establish rules for eligibility (including continued eligibility) of 
any individual to enroll under the terms of the plan or coverage based 
on any of the following health status-related factors in relation to 
the individual or a dependent of the individual:
            ``(1) Health status.
            ``(2) Medical condition (including both physical and mental 
        illnesses).
            ``(3) Claims experience.
            ``(4) Receipt of health care.
            ``(5) Medical history.
            ``(6) Genetic information.
            ``(7) Evidence of insurability (including conditions 
        arising out of acts of domestic violence).
            ``(8) Disability.
            ``(9) Any other health status-related factor determined 
        appropriate by the Secretary.
    ``(b) Programs of Health Promotion or Disease Prevention.--
            ``(1) General provisions.--
                    ``(A) General rule.--For purposes of paragraph 
                (2)(B), a program of health promotion or disease 
                prevention (referred to in this subsection as a 
                `wellness program') shall be a program offered by an 
                employer that is designed to promote health or prevent 
                disease that meets the applicable requirements of this 
                subsection.
                    ``(B) No conditions based on health status 
                factor.--If none of the conditions for obtaining a 
                premium discount or rebate or other reward for 
                participation in a wellness program is based on an 
                individual satisfying a standard that is related to a 
                health status factor, such wellness program shall not 
                violate this section if participation in the program is 
                made available to all similarly situated individuals 
                and the requirements of paragraph (2) are complied 
                with.
                    ``(C) Conditions based on health status factor.--If 
                any of the conditions for obtaining a premium discount 
                or rebate or other reward for participation in a 
                wellness program is based on an individual satisfying a 
                standard that is related to a health status factor, 
                such wellness program shall not violate this section if 
                the requirements of paragraph (3) are complied with.
            ``(2) Wellness programs not subject to requirements.--If 
        none of the conditions for obtaining a premium discount or 
        rebate or other reward under a wellness program as described in 
        paragraph (1)(B) are based on an individual satisfying a 
        standard that is related to a health status factor (or if such 
        a wellness program does not provide such a reward), the 
        wellness program shall not violate this section if 
        participation in the program is made available to all similarly 
        situated individuals. The following programs shall not have to 
        comply with the requirements of paragraph (3) if participation 
        in the program is made available to all similarly situated 
        individuals:
                    ``(A) A program that reimburses all or part of the 
                cost for memberships in a fitness center.
                    ``(B) A diagnostic testing program that provides a 
                reward for participation and does not base any part of 
                the reward on outcomes.
                    ``(C) A program that encourages preventive care 
                related to a health condition through the waiver of the 
                copayment or deductible requirement under an individual 
                or group health plan for the costs of certain items or 
                services related to a health condition (such as 
                prenatal care or well-baby visits).
                    ``(D) A program that reimburses individuals for the 
                costs of smoking cessation programs without regard to 
                whether the individual quits smoking.
                    ``(E) A program that provides a reward to 
                individuals for attending a periodic health education 
                seminar.
            ``(3) Wellness programs subject to requirements.--If any of 
        the conditions for obtaining a premium discount, rebate, or 
        reward under a wellness program as described in paragraph 
        (1)(C) is based on an individual satisfying a standard that is 
        related to a health status factor, the wellness program shall 
        not violate this section if the following requirements are 
        complied with:
                    ``(A) The reward for the wellness program, together 
                with the reward for other wellness programs with 
                respect to the plan that requires satisfaction of a 
                standard related to a health status factor, shall not 
                exceed 30 percent of the cost of employee-only coverage 
                under the plan. If, in addition to employees or 
                individuals, any class of dependents (such as spouses 
                or spouses and dependent children) may participate 
                fully in the wellness program, such reward shall not 
                exceed 30 percent of the cost of the coverage in which 
                an employee or individual and any dependents are 
                enrolled. For purposes of this paragraph, the cost of 
                coverage shall be determined based on the total amount 
                of employer and employee contributions for the benefit 
                package under which the employee is (or the employee 
                and any dependents are) receiving coverage. A reward 
                may be in the form of a discount or rebate of a premium 
                or contribution, a waiver of all or part of a cost-
                sharing mechanism (such as deductibles, copayments, or 
                coinsurance), the absence of a surcharge, or the value 
                of a benefit that would otherwise not be provided under 
                the plan. The Secretaries of Labor, Health and Human 
                Services, and the Treasury may increase the reward 
                available under this subparagraph to up to 50 percent 
                of the cost of coverage if the Secretaries determine 
                that such an increase is appropriate.
                    ``(B) The wellness program shall be reasonably 
                designed to promote health or prevent disease. A 
                program complies with the preceding sentence if the 
                program has a reasonable chance of improving the health 
                of, or preventing disease in, participating individuals 
                and it is not overly burdensome, is not a subterfuge 
                for discriminating based on a health status factor, and 
                is not highly suspect in the method chosen to promote 
                health or prevent disease. The plan or issuer shall 
                evaluate the program's reasonableness at least once per 
                year.
                    ``(C) The plan shall give individuals eligible for 
                the program the opportunity to qualify for the reward 
                under the program at least once each year.
                    ``(D) The full reward under the wellness program 
                shall be made available to all similarly situated 
                individuals. For such purpose, among other things:
                            ``(i) The reward is not available to all 
                        similarly situated individuals for a period 
                        unless the wellness program allows--
                                    ``(I) for a reasonable alternative 
                                standard (or waiver of the otherwise 
                                applicable standard) for obtaining the 
                                reward for any individual for whom, for 
                                that period, it is unreasonably 
                                difficult due to a medical condition to 
                                satisfy the otherwise applicable 
                                standard; and
                                    ``(II) for a reasonable alternative 
                                standard (or waiver of the otherwise 
                                applicable standard) for obtaining the 
                                reward for any individual for whom, for 
                                that period, it is medically 
                                inadvisable to attempt to satisfy the 
                                otherwise applicable standard.
                            ``(ii) If reasonable under the 
                        circumstances, the plan or issuer may seek 
                        verification, such as a statement from an 
                        individual's physician, that a health status 
                        factor makes it unreasonably difficult or 
                        medically inadvisable for the individual to 
                        satisfy or attempt to satisfy the otherwise 
                        applicable standard.
                    ``(E) The plan or issuer involved shall disclose in 
                all plan materials describing the terms of the wellness 
                program the availability of a reasonable alternative 
                standard (or the possibility of waiver of the otherwise 
                applicable standard) required under subparagraph (D). 
                If plan materials disclose that such a program is 
                available, without describing its terms, the disclosure 
                under this subparagraph shall not be required.
    ``(c) Existing Programs.--Nothing in this section shall prohibit a 
program of health promotion or disease prevention that was established 
prior to the date of enactment of this section and applied with all 
applicable regulations, and that is operating on such date, from 
continuing to be carried out for as long as such regulations remain in 
effect.
    ``(d) Regulations.--Nothing in this section shall be construed as 
prohibiting the Secretaries of Labor, Health and Human Services, or the 
Treasury from promulgating regulations in connection with this section.

``SEC. 2707. ENSURING THE QUALITY OF CARE.

    ``(a) In General.--Except as provided in subsection (c), a group 
health plan and a health insurance issuer offering group or individual 
health insurance coverage shall develop and implement a reimbursement 
structure for making payments to health care providers that provides 
incentives for--
            ``(1) the provision of high quality health care under the 
        plan or coverage in a manner that includes--
                    ``(A) the implementation of case management, care 
                coordination, chronic disease management, and 
                medication and care compliance activities that includes 
                the use of the medical home model as defined in section 
                212 of the Affordable Health Choices Act for treatment 
                or services under the plan or coverage;
                    ``(B) the implementation of activities to prevent 
                hospital readmissions through a comprehensive program 
                for hospital discharge that includes patient-centered 
                education and counseling, comprehensive discharge 
                planning, and post-discharge reinforcement by an 
                appropriate health care professional;
                    ``(C) the implementation of activities to improve 
                patient safety and reduce medical errors through the 
                appropriate use of best clinical practices, evidence 
                based medicine, and health information technology under 
                the plan or coverage;
                    ``(D) the implementation of wellness and health 
                promotion activities;
                    ``(E) child health measures under section 1139A of 
                the Social Security Act; and
                    ``(F) culturally and linguistically appropriate 
                care, as defined by the Secretary; and
            ``(2) payment policies that substantially reflects the 
        payment policy of the Medicare program under title XVIII of the 
        Social Security Act and the Children's Health Insurance Program 
        under title XXI of such Act with respect to any generally 
        implemented incentive policy to promote high quality health 
        care, except that in order that no plan or issuer be forced to 
        deny patients medical care needed to prevent their deaths or 
        preserve or restore their health, no plan or issuer shall be 
        prohibited from providing payment for a treatment or diagnostic 
        procedure it chooses to cover, unless such treatment or 
        procedure has been determined to be unsafe or dangerous or 
        capable of neither preventing the patient's death nor 
        preserving or restoring the patient's health.
    ``(b) Wellness and Prevention Programs.--For purposes of subsection 
(a)(1)(D), wellness and health promotion activities may include 
personalized wellness and prevention services, which are coordinated, 
maintained or delivered by a health care provider, a wellness and 
prevention plan manager, or a health, wellness or prevention services 
organization that conducts health risk assessments or offer ongoing 
face-to-face, telephonic or web-based intervention efforts for each of 
the program's participants, and which may include the following 
wellness and prevention efforts:
            ``(1) Smoking cessation.
            ``(2) Weight management.
            ``(3) Stress management.
            ``(4) Physical fitness.
            ``(5) Nutrition.
            ``(6) Heart disease prevention.
            ``(7) Healthy lifestyle support.
            ``(8) Diabetes prevention.
    ``(c) Exceptions.--In promulgating regulations under subsection 
(d), the Secretary may provide for exceptions to the requirements of 
subsection (a) for insurers that substantially meet the goals of this 
section.
    ``(d) Regulations.--Not later than 180 days after the date of 
enactment of the Affordable Health Choices Act, the Secretary shall 
promulgate regulations--
            ``(1) that define the term `generally implemented' for 
        purposes of subsection (a)(2);
            ``(2) that require the expiration of a minimum period of 
        time between the date on which a policy is generally 
        implemented for purposes of subsection (a)(2) and the date on 
        which such policy shall apply with respect to health insurance 
        coverage offered in the individual or group market; and
            ``(3) that provide criteria for determining whether a 
        payment policy is described in subsection (a).
    ``(e) Study and Report.--Not later than 180 days after the date of 
enactment of the Affordable Health Choices Act, the Government 
Accountability Office shall conduct a study and submit to the Committee 
on Health, Education, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of Representatives a 
report regarding the impact the activities under this section have had 
on the quality and cost of health care.

``SEC. 2708. COVERAGE OF PREVENTIVE HEALTH SERVICES.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage shall 
provide coverage for and shall not impose any cost sharing requirements 
(other than minimal cost sharing in accordance with guidelines 
developed by the Secretary) for--
            ``(1) evidence-based items or services that have in effect 
        a rating of `A' or `B' in the current recommendations of the 
        United States Preventive Services Task Force;
            ``(2) immunizations that have in effect a recommendation 
        from the Advisory Committee on Immunization Practices of the 
        Centers for Disease Control and Prevention with respect to the 
        individual involved; and
            ``(3) with respect to infants, children, and adolescents, 
        evidence-informed preventive care and screenings provided for 
        in the comprehensive guidelines supported by the Health 
        Resources and Services Administration.
    ``(b) Interval.--
            ``(1) In general.--The Secretary shall establish a minimum 
        interval between the date on which a recommendation described 
        in subsection (a)(1) or (a)(2) or a guideline under subsection 
        (a)(3) is issued and the plan year with respect to which the 
        requirement described in subsection (a) is effective with 
        respect to the service described in such recommendation or 
        guideline.
            ``(2) Minimum.--The interval described in paragraph (1) 
        shall not be less than 1 year.

``SEC. 2709. COVERAGE OF PREVENTIVE WOMEN'S HEALTH SERVICES.

    ``A group health plan and a health insurance issuer offering group 
or individual health insurance coverage shall provide coverage for, and 
shall not impose any cost sharing requirements (other than minimal cost 
sharing in accordance with guidelines developed by the Secretary) for, 
with respect to women (including pregnant women and individuals of 
child bearing age), such additional preventive care and screenings not 
covered under section 2708 as provided for in guidelines supported by 
the Health Resources and Services Administration.

``SEC. 2710. EXTENSION OF DEPENDENT COVERAGE.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage that 
provides dependent coverage of children shall continue to make such 
coverage available for an adult child until the child turns 26 years of 
age. Nothing in this section shall require a health plan or a health 
insurance issuer described in the preceding sentence to make coverage 
available for a child of a child receiving dependent coverage.
    ``(b) Regulations.--The Secretary shall promulgate regulations to 
define the dependents to which coverage shall be made available under 
subsection (a).

``SEC. 2711. NO LIFETIME OR ANNUAL LIMITS.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may not 
establish lifetime or annual limits on the dollar value of benefits for 
any participant or beneficiary.
    ``(b) Preventing Fraud and Abuse.--This section shall not apply 
until the date on which the Secretary certifies that enacting this 
section will not result in undue proliferation of fraud and abuse, 
especially with regard to durable medical equipment.

``SEC. 2712. NOTIFICATION BY PLANS NOT PROVIDING MINIMUM QUALIFYING 
              COVERAGE.

    ``(a) In General.--Not later than 1 year after the date on which 
the Secretary establishes criteria with respect to minimum qualifying 
coverage under section 3103, a group health plan and a health insurance 
issuer offering group or individual health insurance coverage that 
fails to provide such minimum qualifying coverage shall notify, in such 
manner as may be required by the Secretary, enrollees and prospective 
enrollees in such plan or coverage of such failure prior to enrollment 
or re-enrollment.
    ``(b) Modifications.--If the Secretary modifies the criteria with 
respect to minimum qualifying coverage under section 3103, a group 
health plan or health insurance issuer that fails to provide such 
modified minimum qualifying coverage shall provide the notice required 
under subsection (a) within 60 days of the date of such modification.

``SEC. 2713. NON-DISCRIMINATION IN HEALTH CARE.

    ``A group health plan and a health insurance issuer offering group 
or individual health insurance coverage shall not discriminate with 
respect to participation under the plan or coverage against any health 
care provider who is acting within the scope of that provider's license 
or certification under applicable State law. This section shall not 
require that a group health plan or health insurance issuer contract 
with any health care provider willing to abide by the terms and 
conditions for participation established by the plan or issuer. Nothing 
in this section shall be construed as preventing a group health plan, a 
health insurance issuer, or the Secretary from establishing varying 
reimbursement rates based on quality or performance measures.''.

           PART II--PROVISION APPLICABLE TO THE GROUP MARKET

SEC. 121. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    Subpart 2 of part A of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg-4 et seq.) is amended by adding at the end the 
following:

``SEC. 2720A. PROHIBITION OF DISCRIMINATION BASED ON SALARY.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group health insurance coverage may not establish rules 
relating to the health insurance coverage eligibility (including 
continued eligibility) of any full-time employee under the terms of the 
plan that are based on the total hourly or annual salary of the 
employee.
    ``(b) Limitation.--Subsection (a) shall not be construed to 
prohibit a group health plan or health insurance issuer from 
establishing contribution requirements for enrollment in the plan or 
coverage that provide for the payment by employees with lower hourly or 
annual compensation of a lower dollar or percentage contribution than 
the payment required of a similarly situated employees with a higher 
hourly or annual compensation.''.

                       PART III--OTHER PROVISIONS

SEC. 131. NO CHANGES TO EXISTING COVERAGE.

    (a) Option to Retain Current Insurance Coverage.--
            (1) In general.--Nothing in this Act (or an amendment made 
        by this Act) shall be construed to require that an individual 
        terminate coverage under a group health plan or health 
        insurance coverage in which such individual was enrolled prior 
        to the date of enactment of this title.
            (2) Continuation of coverage.--With respect to a group 
        health plan or health insurance coverage in which an individual 
        was enrolled prior to the date of enactment of this title, this 
        subtitle (and the amendments made by this subtitle) shall not 
        apply to such plan or coverage, regardless of whether the 
        individual renews such coverage after such date of enactment.
    (b) Allowance for Family Members to Join Current Coverage.--With 
respect to a group health plan or health insurance coverage in which an 
individual was enrolled prior to the date of enactment of this title 
and which is renewed after such date, family members of such individual 
shall be permitted to enroll in such plan or coverage if such 
enrollment is permitted under the terms of the plan in effect as of 
such date of enactment.
    (c) Allowance for New Employees to Join Current Plan.--A group 
health plan that provides coverage on the date of enactment of this Act 
may provide for the enrolling of new employees (and their families) in 
such plan, and this subtitle (and the amendments made by this subtitle) 
shall not apply with respect to such plan and such new employees (and 
their families).
    (d) No Additional Benefit.--Subsections (b) and (c) shall only 
apply to individuals described in such subsections and the family 
members of such individuals (as provided for in such subsections).
    (e) Limitation.--Subsections (a) through (d) shall not apply to any 
group health plan or health insurance coverage that has been modified 
to a significant extent with respect to covered benefits or cost 
sharing requirements after the date of enactment of this Act. The 
Secretary shall by regulation establish criteria to determine whether a 
plan or health insurance coverage has been modified to a significant 
extent under the preceding sentence, except that any coverage amendment 
made pursuant to an agreement between an employer or an individual and 
a health insurance issuer relating to the coverage which amends the 
coverage solely to conform to any requirement added by this Act (or 
amendments to this Act) shall not be treated as a significant 
modification.
    (f) Effect on Collective Bargaining Agreements.--In the case of 
health insurance coverage maintained pursuant to one or more collective 
bargaining agreements between employee representatives and one or more 
employers that was ratified before the date of enactment of this title, 
the provisions of this subtitle (and the amendments made by this 
subtitle) shall not apply until the date on which the last of the 
collective bargaining agreements relating to the coverage terminates. 
Any coverage amendment made pursuant to a collective bargaining 
agreement relating to the coverage which amends the coverage solely to 
conform to any requirement added by this subtitle (or amendments) shall 
not be treated as a termination of such collective bargaining 
agreement.
    (g) Risk Adjustment.--The provisions of section 3101(c)(6) of the 
Public Health Service Act (as added by section 142) shall not apply to 
a group health plan or health insurance coverage to which this section 
applies.

SEC. 132. APPLICABILITY.

    Section 2721 of the Public Health Service Act (42 U.S.C. 300gg-21) 
is amended--
            (1) by striking subsection (a);
            (2) in subsection (b)--
                    (A) in paragraph (1), by striking ``1 through 3'' 
                and inserting ``1 and 2''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A), by striking 
                        ``subparagraph (D)'' and inserting 
                        ``subparagraph (D) or (E)'';
                            (ii) by striking ``1 through 3'' and 
                        inserting ``1 and 2''; and
                            (iii) by adding at the end the following:
                    ``(E) Election not applicable.--The election 
                described in subparagraph (A) shall not be available 
                with respect to the provisions of subpart 1.'';
            (3) in subsection (c), by striking ``1 through 3 shall not 
        apply to any group'' and inserting ``1 and 2 shall not apply to 
        any individual coverage or any group''; and
            (4) in subsection (d)--
                    (A) in paragraph (1), by striking ``1 through 3 
                shall not apply to any group'' and inserting ``1 and 2 
                shall not apply to any individual coverage or any 
                group'';
                    (B) in paragraph (2)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``1 through 3 shall not apply 
                        to any group'' and inserting ``1 and 2 shall 
                        not apply to any individual coverage or any 
                        group''; and
                            (ii) in subparagraph (C), by inserting 
                        ``or, with respect to individual coverage, 
                        under any health insurance coverage maintained 
                        by the same health insurance issuer''; and
                    (C) in paragraph (3), by striking ``any group'' and 
                inserting ``any individual coverage or any group''.

SEC. 133. CONFORMING AMENDMENTS.

    (a) Public Health Service Act.--Title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg et seq.) is amended--
            (1) in section 2705 (42 U.S.C. 300gg), as so redesignated 
        by section 101(2)--
                    (A) in subsection (c)--
                            (i) in paragraph (2), by striking ``group 
                        health plan'' each place that such appears and 
                        inserting ``group or individual health plan''; 
                        and
                            (ii) in paragraph (3)--
                                    (I) by striking ``group health 
                                insurance'' each place that such 
                                appears and inserting ``group or 
                                individual health insurance''; and
                                    (II) in subparagraph (D), by 
                                striking ``small or large'' and 
                                inserting ``individual or group'';
                    (B) in subsection (d), by striking ``group health 
                insurance'' each place that such appears and inserting 
                ``group or individual health insurance''; and
                    (C) in subsection (e)(1)(A), by striking ``group 
                health insurance'' and inserting ``group or individual 
                health insurance'';
            (2) by striking the heading for subpart 2 of part A;
            (3) in section 2717 (42 U.S.C. 300gg-4), as so 
        redesignated--
                    (A) in subsection (a), by striking ``health 
                insurance issuer offering group health insurance 
                coverage'' and inserting ``health insurance issuer 
                offering group or individual health insurance 
                coverage'';
                    (B) in subsection (b)--
                            (i) by striking ``health insurance issuer 
                        offering group health insurance coverage in 
                        connection with a group health plan'' in the 
                        matter preceding paragraph (1) and inserting 
                        ``health insurance issuer offering group or 
                        individual health insurance coverage''; and
                            (ii) in paragraph (1), by striking ``plan'' 
                        and inserting ``plan or coverage'';
                    (C) in subsection (c)--
                            (i) in paragraph (2), by striking ``group 
                        health insurance coverage offered by a health 
                        insurance issuer'' and inserting ``health 
                        insurance issuer offering group or individual 
                        health insurance coverage''; and
                            (ii) in paragraph (3), by striking 
                        ``issuer'' and inserting ``health insurance 
                        issuer''; and
                    (D) in subsection (e), by striking ``health 
                insurance issuer offering group health insurance 
                coverage'' and inserting ``health insurance issuer 
                offering group or individual health insurance 
                coverage'';
            (4) in section 2718 (42 U.S.C. 300gg-5), as so 
        redesignated--
                    (A) in subsection (a), by striking ``(or health 
                insurance coverage offered in connection with such a 
                plan)'' each place that such appears and inserting ``or 
                a health insurance issuer offering group or individual 
                health insurance coverage'';
                    (B) in subsection (b), by striking ``(or health 
                insurance coverage offered in connection with such a 
                plan)'' each place that such appears and inserting ``or 
                a health insurance issuer offering group or individual 
                health insurance coverage''; and
                    (C) in subsection (c)--
                            (i) in paragraph (1), by striking ``(and 
                        group health insurance coverage offered in 
                        connection with a group health plan)'' and 
                        inserting ``and a health insurance issuer 
                        offering group or individual health insurance 
                        coverage'';
                            (ii) in paragraph (2), by striking ``(or 
                        health insurance coverage offered in connection 
                        with such a plan)'' each place that such 
                        appears and inserting ``or a health insurance 
                        issuer offering group or individual health 
                        insurance coverage'';
            (5) in section 2719 (42 U.S.C. 300gg-6), as so 
        redesignated, by striking ``health insurance issuers providing 
        health insurance coverage in connection with group health 
        plans'' and inserting ``and health insurance issuers offering 
        group or individual health insurance coverage'';
            (6) in section 2720 (42 U.S.C. 300gg-7), as so 
        redesignated--
                    (A) in subsection (a), by striking ``health 
                insurance coverage offered in connection with such 
                plan'' and inserting ``individual health insurance 
                coverage'';
                    (B) in subsection (b)--
                            (i) in paragraph (1), by striking ``or a 
                        health insurance issuer that provides health 
                        insurance coverage in connection with a group 
                        health plan'' and inserting ``or a health 
                        insurance issuer that offers group or 
                        individual health insurance coverage'';
                            (ii) in paragraph (2), by striking ``health 
                        insurance coverage offered in connection with 
                        the plan'' and inserting ``individual health 
                        insurance coverage''; and
                            (iii) in paragraph (3), by striking 
                        ``health insurance coverage offered by an 
                        issuer in connection with such plan'' and 
                        inserting ``individual health insurance 
                        coverage'';
                    (C) in subsection (c), by striking ``health 
                insurance issuer providing health insurance coverage in 
                connection with a group health plan'' and inserting 
                ``health insurance issuer that offers group or 
                individual health insurance coverage''; and
                    (D) in subsection (e)(1), by striking ``health 
                insurance coverage offered in connection with such a 
                plan'' and inserting ``individual health insurance 
                coverage'';
            (7) by striking the heading for subpart 3;
            (8) in section 2714 (42 U.S.C. 300gg-11), as so 
        redesignated--
                    (A) by striking the section heading and all that 
                follows through subsection (b);
                    (B) in subsection (c)--
                            (i) in paragraph (1)--
                                    (I) in the matter preceding 
                                subparagraph (A), by striking ``small 
                                group'' and inserting ``group and 
                                individual''; and
                                    (II) in subparagraph (B)--
                                            (aa) in the matter 
                                        preceding clause (i), by 
                                        inserting ``and individuals'' 
                                        after ``employers'';
                                            (bb) in clause (i), by 
                                        inserting ``or any additional 
                                        individuals'' after 
                                        ``additional groups''; and
                                            (cc) in clause (ii), by 
                                        striking ``without regard to 
                                        the claims experience of those 
                                        employers and their employees 
                                        (and their dependents) or any 
                                        health status-related factor 
                                        relating to such'' and 
                                        inserting ``and individuals 
                                        without regard to the claims 
                                        experience of those 
                                        individuals, employers and 
                                        their employees (and their 
                                        dependents) or any health 
                                        status-related factor relating 
                                        to such individuals''; and
                            (ii) in paragraph (2), by striking ``small 
                        group'' and inserting ``group or individual'';
                    (C) in subsection (d)--
                            (i) by striking ``small group'' each place 
                        that such appears and inserting ``group or 
                        individual''; and
                            (ii) in paragraph (1)(B)--
                                    (I) by striking ``all employers'' 
                                and inserting ``all employers and 
                                individuals'';
                                    (II) by striking ``those 
                                employers'' and inserting ``those 
                                individuals, employers''; and
                                    (III) by striking ``such 
                                employees'' and inserting ``such 
                                individuals, employees'';
                    (D) by striking subsection (e);
                    (E) by striking subsection (f); and
                    (F) by transferring the remainder of such section 
                to appear at the end of section 2702 (as added by 
                section 101(5));
            (9) in section 2715 (42 U.S.C. 300gg-12), as so 
        redesignated--
                    (A) by striking the section heading and all that 
                follows through subsection (a);
                    (B) in subsection (b)--
                            (i) in the matter preceding paragraph (1), 
                        by striking ``group health plan in the small or 
                        large group market'' and inserting ``health 
                        insurance coverage offered in the group or 
                        individual market'';
                            (ii) in paragraph (1), by inserting ``, or 
                        individual, as applicable,'' after ``plan 
                        sponsor'';
                            (iii) in paragraph (2), by inserting ``, or 
                        individual, as applicable,'' after ``plan 
                        sponsor''; and
                            (iv) by striking paragraph (3) and 
                        inserting the following:
            ``(3) Violation of participation or contribution rates.--In 
        the case of a group health plan, the plan sponsor has failed to 
        comply with a material plan provision relating to employer 
        contribution or group participation rules, pursuant to 
        applicable State law.'';
                    (C) in subsection (c)--
                            (i) in paragraph (1)--
                                    (I) in the matter preceding 
                                subparagraph (A), by striking ``group 
                                health insurance coverage offered in 
                                the small or large group market'' and 
                                inserting ``group or individual health 
                                insurance coverage'';
                                    (II) in subparagraph (A), by 
                                inserting ``or individual, as 
                                applicable,'' after ``plan sponsor'';
                                    (III) in subparagraph (B)--
                                            (aa) by inserting ``or 
                                        individual, as applicable,'' 
                                        after ``plan sponsor''; and
                                            (bb) by inserting ``or 
                                        individual health insurance 
                                        coverage''; and
                                    (IV) in subparagraph (C), by 
                                inserting ``or individuals, as 
                                applicable,'' after ``those sponsors''; 
                                and
                            (ii) in paragraph (2)(A)--
                                    (I) in the matter preceding clause 
                                (i), by striking ``small group market 
                                or the large group market, or both 
                                markets,'' and inserting ``individual 
                                or group market, or all markets,''; and
                                    (II) in clause (i), by inserting 
                                ``or individual, as applicable,'' after 
                                ``plan sponsor''; and
                    (D) by transferring the remainder of such section 
                to appear at the end of section 2703 (as added by 
                section 101(5));
            (10) in section 2716 (42 U.S.C. 300gg-13), as so 
        redesignated--
                    (A) in subsection (a)--
                            (i) in the matter preceding paragraph (1), 
                        by striking ``small employer'' and inserting 
                        ``small employer or an individual'';
                            (ii) in paragraph (1), by inserting ``, or 
                        individual, as applicable,'' after ``employer'' 
                        each place that such appears; and
                            (iii) in paragraph (2), by striking ``small 
                        employer'' and inserting ``employer, or 
                        individual, as applicable,'';
                    (B) in subsection (b)--
                            (i) in paragraph (1)--
                                    (I) in the matter preceding 
                                subparagraph (A), by striking ``small 
                                employer'' and inserting ``employer, or 
                                individual, as applicable,'';
                                    (II) in subparagraph (A), by adding 
                                ``and'' at the end;
                                    (III) by striking subparagraphs (B) 
                                and (C); and
                                    (IV) in subparagraph (D)--
                                            (aa) by inserting ``, or 
                                        individual, as applicable,'' 
                                        after ``employer''; and
                                            (bb) by redesignating such 
                                        subparagraph as subparagraph 
                                        (B);
                            (ii) in paragraph (2)--
                                    (I) by striking ``small employers'' 
                                each place that such appears and 
                                inserting ``employers, or individuals, 
                                as applicable,''; and
                                    (II) by striking ``small employer'' 
                                and inserting ``employer, or 
                                individual, as applicable,''; and
                    (C) by redesignating such section as section 2712 
                and transferring such section to appear after section 
                2711 (as added by section 101(5));
            (11) by redesignating subpart 4 as subpart 2;
            (12) in section 2721 (42 U.S.C. 300gg-21)--
                    (A) by striking subsection (a);
                    (B) by striking ``subparts 1 through 3'' each place 
                that such appears and inserting ``subpart 1''; and
                    (C) by redesignating subsections (b) through (e) as 
                subsections (a) through (d), respectively;
            (13) in section 2722 (42 U.S.C. 300gg-22)--
                    (A) in subsection (a)--
                            (i) in paragraph (1), by striking ``small 
                        or large group markets'' and inserting 
                        ``individual or group market''; and
                            (ii) in paragraph (2), by inserting ``or 
                        individual health insurance coverage'' after 
                        ``group health plans''; and
                    (B) in subsection (b)(1)(B), by inserting 
                ``individual health insurance coverage or'' after 
                ``respect to''; and
            (14) in section 2723(a)(1) (42 U.S.C. 300gg-23), by 
        inserting ``individual or'' before ``group health insurance''.
    (b) Applicability.--Notwithstanding any other provision of the 
Affordable Health Choices Act, nothing in such Act (or an amendment 
made by such Act) shall be construed to--
            (1) authorize the Secretary of Health and Human Services to 
        promulgate regulations that prohibit a group health plan or 
        health insurance issuer from carrying out utilization 
        management techniques that are commonly used as of the date of 
        enactment of this section; or
            (2) restrict the application of the amendments made by this 
        subtitle.
    (c) Technical Amendment to the Employee Retirement Income Security 
Act of 1974.--Subpart B of part 7 of subtitle A of title I of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181 et. 
seq.) is amended, by adding at the end the following:

``SEC. 715. ADDITIONAL MARKET REFORMS.

    ``(a) General Rule.--Except as provided in subsection (b)--
            ``(1) the provisions of subpart 1 of part A of title XXVII 
        of the Public Health Service Act (as amended by the Affordable 
        Health Choices Act) shall apply to group health plans, and 
        health insurance issuers providing health insurance coverage in 
        connection with group health plans, as if included in this 
        subpart; and
            ``(2) to the extent that any provision of this part 
        conflicts with a provision of such subpart 1 with respect to 
        group health plans, or health insurance issuers providing 
        health insurance coverage in connection with group health 
        plans, the provisions of such subpart 1 shall apply.
    ``(b) Exception.--Notwithstanding subsection (a), the provisions of 
sections 2701, 2702, and 2704 of title XXVII of the Public Health 
Service Act (as amended by the Affordable Health Choices Act) shall not 
apply with respect to self-insured group health plans, and the 
provisions of this part shall continue to apply to such plans as if 
such sections of the Public Health Service Act (as so amended) had not 
been enacted.''.
    (d) Technical Amendment to the Internal Revenue Code of 1986.--
Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is 
amended by adding at the end the following:

``SEC. 9815. ADDITIONAL MARKET REFORMS.

    ``(a) General Rule.--Except as provided in subsection (b)--
            ``(1) the provisions of subpart 1 of part A of title XXVII 
        of the Public Health Service Act (as amended by the Affordable 
        Health Choices Act) shall apply to group health plans, and 
        health insurance issuers providing health insurance coverage in 
        connection with group health plans, as if included in this 
        subchapter; and
            ``(2) to the extent that any provision of this subchapter 
        conflicts with a provision of such subpart 1 with respect to 
        group health plans, or health insurance issuers providing 
        health insurance coverage in connection with group health 
        plans, the provisions of such subpart 1 shall apply.
    ``(b) Exception.--Notwithstanding subsection (a), the provisions of 
sections 2701, 2702, and 2704 of title XXVII of the Public Health 
Service Act (as amended by the Affordable Health Choices Act) shall not 
apply with respect to self-insured group health plans, and the 
provisions of this subchapter shall continue to apply to such plans as 
if such sections of the Public Health Service Act (as so amended) had 
not been enacted.''.

SEC. 134. SAVINGS.

    (a) Determination.--The Secretary of the Treasury, in consultation 
with the Secretary of Health and Human Services, shall for each fiscal 
year determine the amount of savings to the Federal Government as a 
result of the enactment of this subtitle.
    (b) Use.--Notwithstanding any other provision of this subtitle (or 
an amendment made by this subtitle), the savings to the Federal 
Government generated as a result of the enactment of this subtitle 
shall be used for deficit reduction.

SEC. 135. EFFECTIVE DATES.

    (a) Applicability.--Except as otherwise provided in subsection (b), 
this subtitle (and the amendments made by this subtitle) shall become 
effective for plan years beginning on or after the date that is 1 year 
after the date of enactment of this Act.
    (b) Delayed Applicability.--Sections 2701, 2702, 2705, and 2706 of 
the Public Health Service Act (as added by section 101) shall become 
effective with respect to group health plans or health insurance 
coverage offered in a State on the date on which such State becomes a 
participating or establishing State under section 3104 of the Public 
Health Service Act (as added by section 142).

            Subtitle B--Available Coverage for All Americans

SEC. 141. BUILDING ON THE SUCCESS OF THE FEDERAL EMPLOYEES HEALTH 
              BENEFITS PROGRAM AND THE HEALTH BENEFITS PROGRAM OF MOST 
              LARGE EMPLOYERS SO ALL AMERICANS HAVE AFFORDABLE HEALTH 
              BENEFIT CHOICES.

    (a) Findings.--The Senate finds that--
            (1) the Federal employees health benefits program under 
        chapter 89 of title 5, United States Code, allows Members of 
        Congress, and section 514 of the Employee Retirement Income 
        Security Act of 1974 allows large employers, to have affordable 
        choices among competing health benefit plans;
            (2) the Federal employees health benefits program ensures 
        that the health benefit plans available to Members of Congress 
        meet minimum standards of quality and effectiveness;
            (3) millions of Americans have no meaningful choice in 
        health benefits, because health benefit plans are either 
        unavailable or unaffordable; and
            (4) all Americans should have the same kinds of meaningful 
        choices of health benefit plans that Members of Congress, as 
        Federal employees, enjoy through the Federal employees health 
        benefits program.
    (b) Sense of the Senate.--It is the sense of the Senate that 
Congress should establish a means for all Americans to enjoy affordable 
choices in health benefit plans, in the same manner that Members of 
Congress have such choices through the Federal employees health 
benefits program.

SEC. 142. AFFORDABLE HEALTH CHOICES FOR ALL AMERICANS.

    (a) Purpose.--It is the purpose of this section to facilitate the 
establishment of Affordable Health Benefit Gateways in each State, with 
appropriate flexibility for States in establishing and administering 
the Gateways.
    (b) American Health Benefit Gateways.--The Public Health Service 
Act ( 42 U.S.C. 201 et seq.) is amended by adding at the end the 
following:

       ``TITLE XXXI--AFFORDABLE HEALTH CHOICES FOR ALL AMERICANS

                    ``Subtitle A--Affordable Choices

``SEC. 3101. AFFORDABLE CHOICES OF HEALTH BENEFIT PLANS.

    ``(a) Assistance to States to Establish American Health Benefit 
Gateways.--
            ``(1) Planning and establishment grants.--Not later than 60 
        days after the date of enactment of this section (or as soon as 
        practicable thereafter), the Secretary shall make awards, from 
        amounts appropriated under paragraph (5), to States in the 
        amount specified in paragraph (2) for the uses described in 
        paragraph (3).
            ``(2) Amount specified.--
                    ``(A) Total determined.--For each fiscal year, the 
                Secretary shall determine the total amount that the 
                Secretary will make available for grants under this 
                subsection.
                    ``(B) State amount.--For each State that is awarded 
                a grant under paragraph (1), the amount of such grants 
                shall be based on a formula established by the 
                Secretary under which each State shall receive an award 
                in an amount that is based on the following two 
                components:
                            ``(i) A minimum amount for each State.
                            ``(ii) An additional amount based on 
                        population.
                The Secretary shall ensure that the aggregate amount 
                awarded to all States under clause (i) is not less than 
                60 percent of the aggregate amount awarded to all 
                States under this subparagraph.
            ``(3) Use of funds.--A State shall use amounts awarded 
        under this subsection for activities (including planning 
        activities) related to establishing an American Health Benefit 
        Gateway, as described in subsection (b).
            ``(4) Renewability of grant.--
                    ``(A) In general.--The Secretary may renew a grant 
                awarded under paragraph (1) if the State recipient of 
                such grant--
                            ``(i) is making progress, as determined by 
                        the Secretary, toward--
                                    ``(I) establishing a Gateway; and
                                    ``(II) implementing the reforms 
                                described in subtitle A of title I of 
                                the Affordable Health Choices Act; and
                            ``(ii) is meeting such other benchmarks as 
                        the Secretary may establish.
                    ``(B) Limitation.--If a State is an establishing 
                State or a participating State (as defined in section 
                3104), such State shall not be eligible for a grant 
                renewal under subparagraph (A) as of the second fiscal 
                year following the date on which such State was deemed 
                to be an establishing State or a participating State.
            ``(5) Authorization of appropriations.--There are 
        authorized to be appropriated such sums as may be necessary to 
        carry out this subsection in each of fiscal years 2009 through 
        2014.
    ``(b) American Health Benefit Gateways.--An American Health Benefit 
Gateway (referred to in this title as a `Gateway') means a mechanism 
that--
            ``(1) facilitates the purchase of health insurance coverage 
        and related insurance products through the Gateway at an 
        affordable price by qualified individuals and qualified 
        employers and reduces the cost of health care; and
            ``(2) meets the requirements of subsection (c).
    ``(c) Requirements.--
            ``(1) Establishment.--A Gateway shall be a governmental 
        agency or nonprofit entity that is established by--
                    ``(A) a State, in the case of an establishing State 
                (as described in section 3104); or
                    ``(B) the Secretary, in the case of a participating 
                State (as described in section 3104).
            ``(2) Offering of coverage.--
                    ``(A) In general.--A Gateway shall make available 
                qualified health plans to qualified individuals and 
                qualified employers.
                    ``(B) Inclusion.--In making available coverage 
                pursuant to subparagraph (A), a Gateway shall include a 
                community health insurance option (as described in 
                section 3106).
                    ``(C) Limitation.--A Gateway may not make available 
                any health plan or other health insurance coverage that 
                is not a qualified health plan.
                    ``(D) Allowance to offer.--A Gateway may make 
                available a qualified health plan notwithstanding any 
                provision of law that may require benefits other than 
                the essential health benefits specified under section 
                3103(a).
                    ``(E) States may require additional benefits.--
                Subject to the requirements of subparagraph (F), a 
                State may require that a qualified health plan offered 
                in such State offer benefits in addition to the 
                essential health benefits described in section 3103(a).
                    ``(F) Additional benefits.--
                            ``(i) No additional federal cost.--A 
                        requirement by a State under subparagraph (E) 
                        that a qualified health plan cover benefits in 
                        addition to the essential health benefits 
                        required shall not affect the amount of a 
                        credit provided under section 3111 with respect 
                        to such plan.
                            ``(ii) State must assume cost.--A State 
                        shall make payments to or on behalf of an 
                        eligible individual to defray the cost of any 
                        additional benefits described in subparagraph 
                        (E).
            ``(3) Functions.--A Gateway shall, at a minimum--
                    ``(A) establish procedures for the certification, 
                recertification, and decertification, consistent with 
                guidelines developed by the Secretary under subsection 
                (m), of health plans as qualified health plans;
                    ``(B) develop and make available tools to allow 
                consumers to receive accurate and culturally and 
                linguistically appropriate information on--
                            ``(i) expected premiums and out of pocket 
                        expenses (taking into account any credits for 
                        which such individual is eligible under section 
                        3111);
                            ``(ii) the availability of in-network and 
                        out-of-network providers;
                            ``(iii) the costs of any surcharge assessed 
                        under paragraph (4);
                            ``(iv) data, by plan, that reflects the 
                        frequency with which preventive services rated 
                        `A' or `B' by the U.S. Preventive Services Task 
                        Force or recommended by the Advisory Committee 
                        on Immunization Practices are utilized by 
                        enrollees, a comparison of such data to the 
                        average frequency with which such preventive 
                        services are utilized by enrollees across all 
                        qualified health plans, and whether such 
                        preventive services are utilized by enrollees 
                        as frequently as recommended;
                            ``(v) medical loss ratios, as reported 
                        under section 2704(a);
                            ``(vi) any quality measures for health plan 
                        performance endorsed under section 399JJ; and
                            ``(vii) such other matters relating to 
                        consumer costs and expected experience under 
                        the plan as a Gateway may determine necessary;
                    ``(C) utilize the administrative simplification 
                measures and standards developed under section 222 of 
                the Affordable Health Choices Act;
                    ``(D) enter into agreements, to the extent 
                determined appropriate by the Gateway, with navigators, 
                as described in section 3105;
                    ``(E) facilitate the purchase of coverage for long-
                term services and supports;
                    ``(F) collect, analyze, and respond to complaints 
                and concerns from enrollees regarding coverage provided 
                through the Gateway;
                    ``(G) provide for the operation of a toll-free 
                telephone hotline to respond to requests for 
                assistance; and
                    ``(H) maintain an Internet website through which 
                enrollees and prospective enrollees of qualified health 
                plans may obtain standardized comparative information 
                on such plans.
            ``(4) Surcharges.--
                    ``(A) In general.--A Gateway may assess a surcharge 
                on all health insurance issuers offering qualified 
                health plans through the Gateway to pay for the 
                administrative and operational expenses of the Gateway.
                    ``(B) Limitation.--A surcharge described in 
                subparagraph (A) may not exceed 4 percent of the 
                premiums collected by a qualified health plan.
                    ``(C) Further limitation.--No funds collected 
                through a Gateway surcharge for administrative and 
                operational expenses may be used for staff retreats, 
                promotional giveaways, excessive executive 
                compensation, or promotion of Federal or State 
                legislative and regulatory modifications.
            ``(5) Risk adjustment payment.--
                    ``(A) Establishing and participating states.--
                            ``(i) Low actuarial risk plans.--Using the 
                        criteria and methods developed under 
                        subparagraph (B), each establishing State or 
                        participating State (as defined in section 
                        3104) shall assess a charge on health plans and 
                        health insurance issuers (with respect to 
                        health insurance coverage) described in 
                        subparagraph (C) if the actuarial risk of the 
                        enrollees of such plans or coverage for a year 
                        is less than the average actuarial risk of all 
                        enrollees in all plans or coverage in such 
                        State for such year that are not self-insured 
                        group health plans (which are subject to the 
                        provisions of the Employee Retirement Income 
                        Security Act of 1974).
                            ``(ii) High actuarial risk plans.--Using 
                        the criteria and methods developed under 
                        subparagraph (B), each establishing State or 
                        participating State (as defined in section 
                        3104) shall provide a payment to health plans 
                        and health insurance issuers (with respect to 
                        health insurance coverage) described in 
                        subparagraph (C) if the actuarial risk of the 
                        enrollees of such plans or coverage for a year 
                        is greater than the average actuarial risk of 
                        all enrollees in all plans and coverage in such 
                        State for such year that are not self-insured 
                        group health plans (which are subject to the 
                        provisions of the Employee Retirement Income 
                        Security Act of 1974).
                    ``(B) Criteria and methods.--The Secretary, in 
                consultation with States, shall establish criteria and 
                methods to be used in carrying out the risk adjustment 
                activities under this paragraph. The Secretary may 
                utilize criteria and methods similar to the criteria 
                and methods utilized under part C or D of title XVIII 
                of the Social Security Act.
                    ``(C) Scope.--A health plan or a health insurance 
                issuer is described in this subparagraph if such health 
                plan or health insurance issuer provides coverage for 
                an individual or for an employer group the size of 
                which does not exceed--
                            ``(i) in the case of an employer with its 
                        primary place of business located in an 
                        establishing State, the criteria relating to 
                        the size of employers established by such State 
                        as described in section 3116(a)(2)(A)(ii)(I); 
                        or
                            ``(ii) in the case of an employer with its 
                        primary place of business located in a 
                        participating State, the criteria relating to 
                        the size of employers established by the 
                        Secretary as described in section 
                        3116(a)(2)(A)(ii)(II).
            ``(6) Facilitating enrollment.--
                    ``(A) In general.--A Gateway shall (through, to the 
                extent practicable, the use of information technology) 
                implement policies and procedures to--
                            ``(i) facilitate the identification of 
                        individuals who lack qualifying coverage; and
                            ``(ii) assist such individuals in enrolling 
                        in--
                                    ``(I) a qualified health plan that 
                                is affordable and available to such 
                                individual, if such individual is a 
                                qualified individual;
                                    ``(II) the medicaid program under 
                                title XIX of the Social Security Act, 
                                if such individual is eligible for such 
                                program;
                                    ``(III) the CHIP program under 
                                title XXI of the Social Security Act, 
                                if such individual is eligible for such 
                                program; or
                                    ``(IV) other Federal programs in 
                                which such individual is eligible to 
                                participate.
                    ``(B) Choice for individuals eligible for chip.--A 
                qualified individual who is eligible for the Children's 
                Health Insurance Program under title XXI of the Social 
                Security Act may elect to enroll in such program or in 
                a qualified health plan. Where such individual is a 
                minor child, such election shall be made by the parent 
                or guardian of such child.
                    ``(C) Oversight.--The Secretary shall oversee the 
                implementation of subparagraph (A)(ii) to ensure that 
                individuals are assisted to enroll in the program most 
                appropriate under such subparagraph for each such 
                individual.
                    ``(D) Accessibility of materials.--Any materials 
                used by a Gateway to carry out this paragraph shall be 
                provided in a form and manner calculated to be 
                understood by individuals who may apply to be enrollees 
                in a qualified health plan, taking into account 
                potential language barriers and disabilities of 
                individuals.
            ``(7) Consultation.--A Gateway shall consult with 
        stakeholders relevant to carrying out the activities under this 
        subsection, including--
                    ``(A) educated health care consumers who are 
                enrollees in qualified health plans;
                    ``(B) individuals and entities with experience in 
                facilitating enrollment in qualified health plans;
                    ``(C) representatives of small businesses and self-
                employed individuals;
                    ``(D) State Medicaid offices; and
                    ``(E) advocates for enrolling hard to reach 
                populations.
            ``(8) Standards and protocols.--
                    ``(A) In general.--The Secretary, in consultation 
                with the Office of the National Coordinator for Health 
                Information Technology, shall develop interoperable, 
                secure, scalable, and reusable standards and protocols 
                that facilitate enrollment of individuals in Federal 
                and State health and human services programs.
                    ``(B) Coordination.--The Secretary shall facilitate 
                enrollment of individuals in programs described in 
                subparagraph (A) through methods which shall include--
                            ``(i) electronic matching against existing 
                        Federal and State data to serve as evidence of 
                        eligibility and digital documentation in lieu 
                        of paper-based documentation;
                            ``(ii) capability for individuals to apply, 
                        recertify, and manage eligibility information 
                        online, including conducting real-time queries 
                        against databases for existing eligibility 
                        prior to submitting applications; and
                            ``(iii) other functionalities necessary to 
                        provide eligible individuals with a streamlined 
                        enrollment process.
                    ``(C) Assistance.--The Secretary shall award grants 
                to enhance community-based enrollment to--
                            ``(i) States to assist such States in--
                                    ``(I) contracting with qualified 
                                technology vendors to develop or 
                                acquire electronic enrollment software 
                                systems;
                                    ``(II) contracting with community 
                                and consumer focused nonprofit 
                                organizations with experience working 
                                with consumers, including the uninsured 
                                and the underinsured, to establish 
                                Statewide helplines for enrollment 
                                assistance and referrals; and
                                    ``(III) establishing public 
                                education campaigns through grants to 
                                qualifying organizations for the design 
                                and implementation of public education 
                                campaigns targeting uninsured and 
                                traditionally underserved communities; 
                                and
                            ``(ii) community-based organizations for 
                        infrastructure and training to establish 
                        electronic assistance programs.
            ``(9) Notification.--With respect to the standards and 
        protocols developed under paragraph (8), the Secretary--
                    ``(A) shall notify States of such standards and 
                protocols; and
                    ``(B) may require, as a condition of receiving 
                Federal funds, that States or other entities 
                incorporate such standards and protocols into such 
                investments.
            ``(10) Publication of costs.--A Gateway shall publish the 
        average costs of income or other taxes, licensing or regulatory 
        fees, and any surcharges imposed by the Gateway, and the 
        administrative costs of such Gateway, on an Internet website to 
        educate consumers on such costs. Such information shall also 
        include monies lost to waste, fraud, and abuse.
    ``(d) Certification.--A Gateway may certify a health plan as a 
qualified health plan if--
            ``(1) such health plan meets the requirements of subsection 
        (m);
            ``(2) the Gateway determines that making available such 
        health plan through such Gateway is in the interests of 
        qualified individuals and qualified employers in the States or 
        States in which such Gateway operates, except that the Gateway 
        may not exclude a health plan--
                    ``(A) on the basis that such plan is a fee-for-
                service plan;
                    ``(B) through the imposition of premium price 
                controls; or
                    ``(C) on the basis that the plan provides 
                treatments necessary to prevent patients' deaths in 
                circumstances the Gateway determines are inappropriate 
                or to costly; and
            ``(3) the Gateway determines that the plan has not 
        established a pattern or practice under which benefits covered 
        by the plan are denied to covered individuals on the basis of 
        the individuals' age or expected length of life or of the 
        individuals' present or predicted disability, degree of medical 
        dependency, or quality of life.
    ``(e) Guidance.--The Secretary shall develop guidance that may be 
used by a Gateway to carry out the activities described in this 
section.
    ``(f) Flexibility.--
            ``(1) Regional or other interstate gateways.--A Gateway may 
        operate in more than one State, provided that each State in 
        which such Gateway operates permits such operation.
            ``(2) Subsidiary gateways.--A State may establish one or 
        more subsidiary Gateway, provided that--
                    ``(A) each such Gateway serves a geographically 
                distinct area; and
                    ``(B) the area served by each such Gateway is at 
                least as large as a community rating area described in 
                section 2701.
    ``(g) No Limitation on Contracting Based on Abortion.--No 
individual health care provider or health care facility may be excluded 
from contracting with a health insurance issuer participating in the 
Gateway on the basis that the provider or facility performs abortions 
or the provider or facility refuses to perform abortions, except in an 
emergency, if performing abortions is contrary to the religious or 
moral beliefs of the provider or facility.
    ``(h) Portals to State Gateway.--The Secretary shall establish a 
mechanism, including an Internet website, through which a resident of 
any State may identify any Gateway operating in such State.
    ``(i) Choice.--
            ``(1) Qualified individuals.--A qualified individual may 
        enroll in any qualified health plan available to such 
        individual.
            ``(2) Qualified employers.--
                    ``(A) Employer may specify tier.--A qualified 
                employer may provide support for coverage of employees 
                under a qualified health plan by selecting any tier of 
                cost sharing described in section 3111(a)(1).
                    ``(B) Employee may choose plans within a tier.--
                Each employee of a qualified employer may choose to 
                enroll in a qualified health plan that offers coverage 
                at the tier of cost sharing selected by an employer, as 
                described in subparagraph (A).
            ``(3) Self-employed individuals.--
                    ``(A) Deeming.--An individual who is self-employed 
                (as defined in section 401(c)(1) of the Internal 
                Revenue Code of 1986) shall be deemed to be a qualified 
                employer unless such individual notifies the applicable 
                Gateway that such individual elects to be considered a 
                qualified individual.
                    ``(B) Eligibility.--In the case of a self-employed 
                individual making the election described in 
                subparagraph (A)--
                            ``(i) the income of such individual for 
                        purposes of section 3111 shall be deemed to be 
                        the total business income of such individual;
                            ``(ii) premium payments made by such 
                        individual to a qualified health plan shall not 
                        be treated as employer-provided coverage under 
                        section 106(a) of the Internal Revenue Code of 
                        1986; and
                            ``(iii) the individual shall not be 
                        eligible for a credit under section 3112.
    ``(j) Payment of Premiums by Qualified Individuals.--A qualified 
individual enrolled in any qualified health plan may pay any applicable 
premium owed by such individual to the health insurance issuer issuing 
such qualified health plan.
    ``(k) Single Risk Pool.--
            ``(1) Individual market.--A health insurance issuer shall 
        consider all enrollees in an individual plan, including 
        individuals who do not purchase such a plan through the 
        Gateway, to be members of a single risk pool.
            ``(2) Group health insurance policies.--A health insurance 
        issuer shall consider all enrollees in a small group health 
        plan, other than a self-insured group health plan, including 
        individuals who do not purchase such a plan through the 
        Gateway, to be members of a single risk pool.
    ``(l) Empowering Consumer Choice.--
            ``(1) Continued operation of market outside gateways.--
        Nothing in this title shall be construed to prohibit a health 
        insurance issuer from offering a health insurance policy or 
        providing coverage under such policy to a qualified individual 
        where such policy is not a qualified health plan. Nothing in 
        this title shall be construed to prohibit a qualified 
        individual from enrolling in a health insurance plan where such 
        plan is not a qualified health plan.
            ``(2) Continued operation of state benefit requirements.--
        Nothing in this title shall be construed to terminate, abridge, 
        or limit the operation of any requirement under State law with 
        respect to any policy or plan that is not a qualified health 
        plan to offer benefits required under State law.
            ``(3) Voluntary nature of a gateway.--
                    ``(A) Choice to enroll or not to enroll.--Nothing 
                in this title shall be construed to restrict the choice 
                of a qualified individual to enroll or not to enroll in 
                a qualified health plan or to participate in a Gateway.
                    ``(B) Prohibition against compelled enrollment.--
                Nothing in this title shall be construed to compel an 
                individual to enroll in a qualified health plan or to 
                participate in a Gateway.
    ``(m) Criteria for Certification.--
            ``(1) In general.--The Secretary shall, by regulation, 
        establish criteria for certification of health plans as 
        qualified health plans. Such criteria shall require that, to be 
        certified, a plan--
                    ``(A) not employ marketing practices that have the 
                effect of discouraging the enrollment in such plan by 
                individuals with significant health needs;
                    ``(B) employ methods to ensure that insurance 
                products are simple, comparable, and structured for 
                ease of consumer choice;
                    ``(C) ensure a wide choice of providers (in a 
                manner consistent with applicable network adequacy 
                provisions under section 2702(c));
                    ``(D) include within health insurance plan networks 
                those essential community providers, where available, 
                that serve predominately low-income, medically-
                underserved individuals, such as health care providers 
                defined in section 340B(a)(4) of the Public Health 
                Service Act and providers described in section 
                1927(c)(1)(D)(i)(IV) of the Social Security Act as set 
                forth by section 221 of Public Law 111-8;
                    ``(E) make available to individuals enrolled in, or 
                seeking to enroll in, such plan a detailed description 
                of--
                            ``(i) benefits offered, including maximums, 
                        limitations (including differential cost-
                        sharing for out of network services), 
                        exclusions and other benefit limitations;
                            ``(ii) the service area;
                            ``(iii) required premiums;
                            ``(iv) cost-sharing requirements;
                            ``(v) the manner in which enrollees access 
                        providers; and
                            ``(vi) the grievance and appeals 
                        procedures;
                    ``(F) provide coverage for at least the essential 
                health care benefits established under section 3103(a);
                    ``(G)(i) is accredited by the National Committee 
                for Quality Assurance or by any other entity recognized 
                by the Secretary for the accreditation of health 
                insurance issuers or plans; or
                    ``(ii) receives such accreditation within a period 
                established by a Gateway for such accreditation that is 
                applicable to all qualified health plans;
                    ``(H) implement a quality improvement strategy 
                described in subsection (n)(1);
                    ``(I) have adequate procedures in place for appeals 
                of coverage determinations;
                    ``(J) may not establish a benefit design that is 
                likely to substantially discourage enrollment by 
                certain qualified individuals in such plan; and
                    ``(K) report to the applicable Gateway data on any 
                quality measures for health plan performance endorsed 
                under section 399JJ.
            ``(2) Request to national association of insurance 
        commissioners.--The Secretary shall request the National 
        Association of Insurance Commissioners to develop and submit to 
        the Secretary model criteria for the certification of qualified 
        health plans, that address the elements described in 
        subparagraphs (A) through (K) of paragraph (1). In developing 
        such criteria, the National Association of Insurance 
        Commissioners shall consult with appropriate Federal agencies, 
        consumer representatives, insurance carriers, and other 
        stakeholders.
            ``(3) Required consideration.--If the model criteria 
        described in paragraph (2) are submitted to the Secretary by 
        the date that is 9 months after the date on which a request is 
        made under such paragraph, the Secretary shall consider such 
        model criteria in promulgating the regulations under paragraph 
        (1).
            ``(4) Rule of construction.--Nothing in paragraph (1)(D) 
        shall be construed to require a qualified health plan to 
        contract with a provider described in such paragraph if such 
        provider refuses to accept the generally applicable payment 
        rates of such plan.
    ``(n) Rewarding Quality Through Market-Based Incentives.--
            ``(1) Strategy described.--A strategy described in this 
        paragraph is a payment structure that provides increased 
        reimbursement or other incentives for--
                    ``(A) improving health outcomes through the 
                implementation of activities that shall include quality 
                reporting, effective case management, care 
                coordination, chronic disease management, medication 
                and care compliance initiatives, including through the 
                use of the medical home model as defined in section 212 
                of the Affordable Health Choices Act, for treatment or 
                services under the plan or coverage;
                    ``(B) the implementation of activities to prevent 
                hospital readmissions through a comprehensive program 
                for hospital discharge that includes patient-centered 
                education and counseling, comprehensive discharge 
                planning, and post discharge reinforcement by an 
                appropriate health care professional;
                    ``(C) the implementation of activities to improve 
                patient safety and reduce medical errors through the 
                appropriate use of best clinical practices, evidence 
                based medicine, and health information technology under 
                the plan or coverage; and
                    ``(D) the implementation of wellness and health 
                promotion activities.
            ``(2) Guidelines.--The Secretary, in consultation with 
        experts in health care quality and stakeholders, shall develop 
        guidelines concerning the matters described in paragraph (1).
            ``(3) Requirements.--The guidelines developed under 
        paragraph (2) shall require the periodic reporting to the 
        applicable Gateway of the activities that a qualified health 
        plan has conducted to implement a strategy described in 
        paragraph (1).
    ``(o) No Interference With State Regulatory Authority.--Nothing in 
this title shall be construed to preempt any State law that does not 
prevent the application of the provisions of this title.
    ``(p) Quality Improvement.--
            ``(1) Enhancing patient safety.--Beginning on January 1, 
        2012 a qualified health plan may contract with--
                    ``(A) a hospital with greater than 50 beds only if 
                such hospital--
                            ``(i) utilizes a patient safety evaluation 
                        system as described in part C of title IX; and
                            ``(ii) implements a mechanism to ensure 
                        that each patient receives a comprehensive 
                        program for hospital discharge that includes 
                        patient-centered education and counseling, 
                        comprehensive discharge planning, and post 
                        discharge reinforcement by an appropriate 
                        health care professional; or
                    ``(B) a health care provider if such provider 
                implements such mechanisms to improve health care 
                quality as the Secretary may by regulation require.
            ``(2) Exceptions.--The Secretary may establish reasonable 
        exceptions to the requirements described in paragraph (1).
            ``(3) Adjustment.--The Secretary may by regulation adjust 
        the number of beds described in paragraph (1)(A).
    ``(q) Continued Applicability of Mental Health Parity.--Section 
2716 shall apply to qualified health plans in the same manner and to 
the same extent as such section applies to health insurance issuers and 
group health plans.
    ``(r) Promotion of Informed Choice of Health Insurance Coverage.--
            ``(1) In general.--The Secretary shall develop standards 
        for use by health insurance issuers offering health insurance 
        coverage through the Gateway in the individual or group market 
        in compiling and providing to enrollees a summary of benefits 
        explanation that accurately represents the benefits and 
        coverage provided by the issuer under each of its applicable 
        health insurance products. In developing such standards, the 
        Secretary shall consult with the National Association of 
        Insurance Commissioners, a working group composed of 
        representatives of health insurance-related consumer advocacy 
        organizations, health insurance issuers, health care 
        professionals, patient advocates including those representing 
        individuals with limited English proficiency, and other 
        qualified individuals.
            ``(2) Requirements.--The standards for the summary of 
        benefits explanation developed under paragraph (1) shall 
        provide for the following:
                    ``(A) Appearance.--The standards shall ensure that 
                the summary is presented in a uniform format.
                    ``(B) Language.--The standards shall ensure that 
                the language used in the summary is presented in a 
                manner determined to be understandable by the average 
                health plan enrollee.
                    ``(C) Contents.--The standards shall ensure that 
                the summary includes the following:
                            ``(i) Information determined to be 
                        essential to a consumer's understanding of the 
                        applicable health insurance plan benefits.
                            ``(ii) Uniform definitions of standard 
                        insurance terms including premium, deductible, 
                        co-insurance, co-payment, out-of-pocket limit, 
                        preferred provider, non-preferred provider, 
                        out-of-network co-payments, usual, customary 
                        and reasonable fees, excluded services, 
                        grievance and appeals, prior authorization, 
                        precertification, and such other terms as 
                        determined by the Secretary so that consumers 
                        may compare health insurance coverage and 
                        understand the terms of coverage.
                            ``(iii) Uniform definitions of medical 
                        terms including hospitalization, hospital 
                        outpatient care, emergency room care, physician 
                        services, prescription drug coverage, durable 
                        medical equipment, home health care, skilled 
                        nursing care, rehabilitation services, hospice 
                        services, emergency medical transportation, and 
                        such other terms as determined by the Secretary 
                        so that consumers may compare the medical 
                        benefits and understand the extent of those 
                        medical benefits (or exceptions to those 
                        benefits).
                            ``(iv) A statement of whether the plan 
                        meets minimum qualifying coverage (when 
                        effective under section 3103.)
                            ``(v) Examples to illustrate common 
                        benefits scenarios, including scenarios that 
                        illustrate the health care needs of pregnancy 
                        and of at least several serious or chronic 
                        medical conditions.
                            ``(vi) Illustrations that enhance consumer 
                        understanding of the explanation.
            ``(3) Requirement to provide.--Not later than 12 months 
        after the Secretary develops standards under paragraph (1), 
        each health insurance issuer offering health insurance coverage 
        through the Gateway shall, prior to any enrollment restriction, 
        provide annually to enrollees and potential enrollees a summary 
        of benefits explanation pursuant to the standards developed by 
        the Secretary under paragraph (1)
            ``(4) Preemption.--The standards developed under paragraph 
        (1) shall preempt any related State standards that require 
        summary of benefits health plan explanations that provide less 
        information to consumers, as determined by the Secretary.
            ``(5) Failure to provide.--A health insurance issuer that 
        willfully fails to provide the information required under this 
        subsection shall be subject to a fine of not more than $1,000 
        for each such failure. Such failure with respect to each 
        enrollee shall constitute a separate offense for purposes of 
        this paragraph.
            ``(6) Application.--The provisions of this subsection shall 
        apply to health insurance coverage offered through the Gateway. 
        The Secretary shall evaluate the impact on consumers of 
        expanding the application of the provisions of this subsection 
        to additional health insurance issuers.
    ``(s) Disclosure of Information.--
            ``(1) In general.--In connection with the offering of any 
        health insurance coverage in the individual or group market 
        through a Gateway, a health insurance issuer--
                    ``(A) shall disclose to such individual or employer 
                as part of its solicitation and sales materials, the 
                information described in paragraph (2);
                    ``(B) shall disclose to such individual or employer 
                enrolled in such plan any change and an explanation of 
                such change with respect to the information described 
                in paragraph (2) with reasonable and timely advance 
                notice with respect to such change;
                    ``(C) upon the request of such individual or 
                employer, shall provide the information described in 
                paragraph (2); and
                    ``(D) shall disclose such information as the 
                Secretary may require in order to ensure compliance 
                with consumer protection provisions under this title.
            ``(2) Information described.--
                    ``(A) In general.--Subject to subparagraph (C), 
                with respect to a health insurance issuer offering 
                health insurance coverage in the individual or group 
                market through a Gateway, information disclosed under 
                this paragraph shall include--
                            ``(i) the provisions of such coverage 
                        concerning the issuer's right to change premium 
                        rates, co-payments, in- and out-of-provider 
                        networks, or any other information as 
                        determined by the Secretary; and
                            ``(ii) the benefits and premiums available 
                        under all health insurance coverage for which 
                        an individual or employers is qualified.
                    ``(B) Form of information.--Information shall be 
                provided under this paragraph in a manner determined to 
                be understandable by the average employer or individual 
                and shall be sufficient to reasonably inform such 
                employer or individual of their rights and obligations 
                under the health insurance coverage involved.
                    ``(C) Exception.--Information described under this 
                paragraph shall not include information that is 
                proprietary or trade secret information.

``SEC. 3102. FINANCIAL INTEGRITY.

    ``(a) Accounting for Expenditures.--
            ``(1) In general.--A Gateway shall keep an accurate 
        accounting of all activities, receipts, and expenditures and 
        shall annually submit to the Secretary a report concerning such 
        accountings.
            ``(2) Investigations.--The Secretary may investigate the 
        affairs of a Gateway, may examine the properties and records of 
        a Gateway, and may require periodical reports in relation to 
        activities undertaken by a Gateway. A Gateway shall fully 
        cooperate in any investigation conducted under this paragraph.
            ``(3) Audits.--A Gateway shall be subject to annual audits 
        by the Secretary.
            ``(4) Pattern of abuse.--If the Secretary determines that a 
        Gateway or a State has engaged in serious misconduct with 
        respect to compliance with the requirements of, or carrying out 
        activities required under, this title, the Secretary may 
        rescind from payments otherwise due to such State involved 
        under this or any other Act administered by the Secretary an 
        amount not to exceed 1 percent of such payments per year until 
        corrective actions are taken by the State that are determined 
        to be adequate by the Secretary.
            ``(5) Protections against fraud and abuse.--With respect to 
        activities carried out under this title, the Secretary shall 
        provide for the efficient and non-discriminatory administration 
        of Gateway activities and implement any measure or procedure 
        that--
                    ``(A) the Secretary determines is appropriate to 
                reduce fraud and abuse in the administration of this 
                title; and
                    ``(B) the Secretary has authority to implement 
                under this title or any other Act;
            ``(6) Application of the false claims act.--
                    ``(A) In general.--Payments made by, through, or in 
                connection with a Gateway are subject to the False 
                Claims Act (31 U.S.C. 3729 et seq.) if those payments 
                include any Federal funds. Compliance with the 
                requirements of this Act concerning eligibility for a 
                health insurance issuer to participate in the Gateway 
                shall be a material condition of an issuer's 
                entitlement to receive payments, including subsidy 
                payments, through the Gateway.
                    ``(B) Damages.--Notwithstanding paragraph (1) of 
                section 3729(a) of title 31, United States Code, and 
                subject to paragraph (2) of such section, the civil 
                penalty assessed under the False Claims Act on any 
                person found liable under such Act as described in 
                subparagraph (A) shall be increased by not less than 3 
                times and not more than 6 times the amount of damages 
                which the Government sustains because of the act of 
                that person.
    ``(b) GAO Oversight.--Not later than 5 years after the date of 
enactment of this section, the Comptroller General shall conduct an 
ongoing study of Gateway activities and the enrollees in qualified 
health plans offered through Gateways. Such study shall review--
            ``(1) the operations and administration of Gateways, 
        including surveys and reports of qualified health plans offered 
        through Gateways and on the experience of such plans (including 
        data on enrollees in Gateways and individuals purchasing health 
        insurance coverage outside of Gateways), the expenses of 
        Gateways, claims statistics relating to qualified health plans, 
        complaints data relating to such plans, and the manner in which 
        Gateways meets their goals;
            ``(2) any significant observations regarding the 
        utilization and adoption of Gateways;
            ``(3) where appropriate, recommendations for improvements 
        in the operations or policies of Gateways; and
            ``(4) how many physicians, by area and specialty, are not 
        taking or accepting new patients enrolled in Federal Government 
        health care programs, and the adequacy of provider networks of 
        Federal Government health care programs.

``SEC. 3103. PROGRAM DESIGN.

    ``(a) Program Design.--
            ``(1) In general.--The Secretary shall establish the 
        following:
                    ``(A) Subject to paragraph (2), the essential 
                health care benefits eligible for credits under section 
                3111, where such benefits shall include at least the 
                following general categories:
                            ``(i) Ambulatory patient services.
                            ``(ii) Emergency services.
                            ``(iii) Hospitalization.
                            ``(iv) Maternity and newborn care.
                            ``(v) Mental health and substance abuse 
                        services.
                            ``(vi) Prescription drugs.
                            ``(vii) Rehabilitative and habilitative 
                        services and devices.
                            ``(viii) Laboratory services.
                            ``(ix) Preventive and wellness services.
                            ``(x) Pediatric services, including oral 
                        and vision care.
                    ``(B) The criteria that coverage must meet to be 
                considered minimum qualifying coverage.
                    ``(C) The conditions under which coverage shall be 
                considered affordable and available coverage for 
                individuals and families at different income levels.
                    ``(D) The essential benefits provided for in 
                subparagraph (A) shall include a requirement that there 
                be non-discrimination in health care in a manner that, 
                with respect to an individual who is eligible for 
                medical or surgical care under a qualified health plan 
                offered through a Gateway, prohibits the Administrator 
                of the Gateway, or a qualified health plan offered 
                through the Gateway, from denying such individual 
                benefits for religious or spiritual health care, except 
                that such religious or spiritual health care shall be 
                an expense eligible for deduction as a medical care 
                expense as determined by Internal Revenue Service 
                Rulings interpreting section 213(d) of the Internal 
                Revenue Code of 1986 as of January 1, 2009.
            ``(2) Limitation.--The Secretary shall ensure that the 
        scope of the essential health benefits under paragraph (1)(A) 
        is equal to the scope of benefits provided under a typical 
        employer plan, as determined by the Secretary.
            ``(3) Certification.--In establishing the essential health 
        benefits described in paragraph (1)(A), the Secretary shall 
        submit a report to the appropriate committees of Congress 
        containing a certification from the Chief Actuary of the 
        Centers for Medicare & Medicaid Services that such essential 
        health benefits meet the limitation described in paragraph (2).
    ``(b) National Independent Commission on Essential Health Care 
Benefits.--
            ``(1) Establishment.--There is established a temporary 
        advisory commission to be known as the National Independent 
        Commission on Essential Health Care Benefits (in this section 
        referred to as the `Commission').
            ``(2) Duties.--The Commission shall:
                    ``(A) Review and analyze the benefits offered under 
                typical employer-sponsored health plans, and State laws 
                requiring coverage of specified items and services in 
                the individual and group insurance markets.
                    ``(B) Hold public hearings, meetings, or other 
                public listening sessions not less than 3 times to take 
                testimony and receive such evidence as the Commission 
                considers advisable to carry out activities under this 
                section.
                    ``(C) Make recommendations to the Secretary 
                regarding the specific items and services that should 
                be included in the essential heath care benefits 
                package eligible for credits under section 3111.
            ``(3) Considerations.--The Commission shall consider--
                    ``(A) the clinical appropriateness and 
                effectiveness of the benefits covered;
                    ``(B) the affordability of the benefits covered;
                    ``(C) the financial protection of enrollees against 
                high healthcare expenses;
                    ``(D) access to necessary healthcare services, 
                including primary and preventive health services;
                    ``(E) existing State laws that require coverage of 
                health care items or services in the individual and 
                group markets; and
                    ``(F) the potential of additional or expanded 
                benefits to increase costs and the interactions between 
                the addition or expansion of benefits and reductions in 
                existing benefits to meet the actuarial limitations 
                described in subsection (a)(2).
            ``(4) Membership.--
                    ``(A) Number and appointment.--The Commission shall 
                be composed of 17 members to be appointed by the 
                Secretary.
                    ``(B) Qualifications.--
                            ``(i) In general.--The membership of the 
                        Commission shall include individuals with 
                        national recognition for their expertise in 
                        clinical medicine, primary and preventive 
                        health care, integrative medicine, and 
                        actuarial science and health plan benefit 
                        design.
                            ``(ii) Inclusion.--The membership of the 
                        Commission shall include an expert in actuarial 
                        science and health plan benefit design, a 
                        health care provider, a patient or consumer 
                        advocate, a representative of labor 
                        organizations representing workers, an 
                        employer, a third-party payer, a health 
                        services researcher, an individual skilled in 
                        the conduct and interpretation of the 
                        biomedical and health sciences, an individual 
                        with expertise in pediatric health care, and an 
                        individual with expertise in outcomes and 
                        effectiveness research and technology 
                        assessment.
                    ``(C) Chairman.--The Secretary shall designate a 
                member of the Commission who is an expert in actuarial 
                science and health plan benefit design, at the time of 
                appointment of such member, as Chairman.
                    ``(D) Meetings.--The Commission shall meet at the 
                call of the Chairman. Advance notice of such meetings 
                shall be published in the Federal Register and the 
                meetings shall be open to the public.
                    ``(E) Ethical disclosures.--The Secretary shall 
                establish a system for public disclosure by members of 
                the Commission of financial and other potential 
                conflicts of interest relating to such members.
                    ``(F) Deadline for appointment.--Members of the 
                Commission shall be appointed by not later than 45 days 
                after the date of enactment of this title.
                    ``(G) Terms of appointment.--The term of any 
                appointment under subparagraph (A) to the Commission 
                shall be for the life of the Commission.
                    ``(H) Compensation.--Members of the Commission 
                shall receive no additional pay, allowances, or 
                benefits by reason of their service on the Commission.
                    ``(I) Expenses.--Each member of the Commission 
                shall receive travel expenses and per diem in lieu of 
                subsistence in accordance with sections 5702 and 5703 
                of title 5, United States Code.
            ``(5) Staff and support services.--
                    ``(A) Executive director.--
                            ``(i) Appointment.--The Secretary shall 
                        appoint an executive director of the 
                        Commission.
                            ``(ii) Compensation.--The executive 
                        director of the Commission shall be paid the 
                        rate of basic pay for level V of the Executive 
                        Schedule.
                            ``(iii) Staff.--With the approval of the 
                        Commission, the executive director may appoint 
                        such personnel as the executive director 
                        considers appropriate.
                            ``(iv) Applicability of civil service 
                        laws.--The staff of the Commission shall be 
                        appointed without regard to the provisions of 
                        title 5, United States Code, governing 
                        appointments in the competitive service, and 
                        shall be paid without regard to the provisions 
                        of chapter 51 and subchapter III of chapter 53 
                        of such title (relating to classification and 
                        General Schedule pay rates).
                            ``(v) Experts and consultants.--With the 
                        approval of the Commission, the executive 
                        director may procure temporary and intermittent 
                        services under section 3109(b) of title 5, 
                        United States Code.
            ``(6) Powers.--
                    ``(A) Cost estimates by office of management and 
                budget and office of the chief actuary of the centers 
                for medicare & medicare services.--The Director of the 
                Office of Management and Budget or the Chief Actuary of 
                the Centers for Medicare & Medicaid Services, or both, 
                shall provide to the Commission, upon the request of 
                the Commission, such cost estimates as the Commission 
                determines to be necessary to carry out its duties 
                under this section.
                    ``(B) Technical assistance.--Upon the request of 
                the Commission, the head of a Federal agency or its 
                representatives, including representatives of the 
                Office of Personnel Management, shall provide such 
                technical assistance to the Commission as the 
                Commission determines to be necessary to carry out its 
                duties under this section.
                    ``(C) Obtaining information.--The Commission may 
                secure directly from any Federal agency information 
                necessary to enable it to carry out its duties, if the 
                information may be disclosed under section 552 of title 
                5, United States Code.
                    ``(D) Public input.--The Commission shall adopt 
                procedures allowing any interested party to submit 
                information for the Commission's use in making reports 
                and recommendations.
            ``(7) Report.--Not later than 6 months after the date of 
        enactment of this title, the Commission shall submit a report 
        to the Secretary and Congress which shall contain a detailed 
        statement of only those recommendations, findings, and 
        conclusions of the Commission that receive the approval of at 
        least 12 members of the Commission. The Secretary shall provide 
        for publication in the Federal Register and the posting on an 
        appropriate Internet website of the report and recommendations 
        of the Commission.
            ``(8) Termination.--The Commission shall terminate on the 
        date that is 30 days after the date on which the report is 
        submitted under subsection (7).
            ``(9) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this subsection, 
        $1,500,000.
    ``(c) Required Elements for Consideration.--
            ``(1) Essential health care benefits.--In establishing the 
        essential health benefits under subsection (a)(1)(A), the 
        Secretary shall--
                    ``(A) consider the report and recommendations of 
                the Commission established under subsection (b);
                    ``(B) ensure that such essential health benefits 
                reflect an appropriate balance among the categories 
                described in such subsection, so that benefits are not 
                unduly weighted toward any category;
                    ``(C) not make coverage decisions, determine 
                reimbursement rates, establish incentive programs, or 
                design benefits in ways that discriminate against 
                individuals because of their age, disability, or 
                expected length of life;
                    ``(D) take into account the health care needs of 
                diverse segments of the population, including women, 
                children, persons with disabilities, and other groups;
                    ``(E) ensure that health benefits established as 
                essential not be subject to denial to individuals 
                against their wishes on the basis of the individuals' 
                age or expected length of life or of the individuals' 
                present or predicted disability, degree of medical 
                dependency, or quality of life; and
                    ``(F) review the essential health benefits under 
                subsection (a)(1)(A) not less than annually, and 
                provide a report to Congress and the public that 
                contains--
                            ``(i) an assessment of whether enrollees 
                        are facing any difficulty accessing needed 
                        services for reasons of coverage or cost;
                            ``(ii) an assessment of whether the 
                        essential benefits package needs to be modified 
                        or updated to account for changes in medical 
                        evidence or scientific advancement;
                            ``(iii) information on how the benefit 
                        package will be modified to address any such 
                        gaps in access or changes in the evidence base; 
                        and
                            ``(iv) an assessment of the potential of 
                        additional or expanded benefits to increase 
                        costs and the interactions between the addition 
                        or expansion of benefits and reductions in 
                        existing benefits to meet actuarial limitations 
                        described in subsection (a)(2).
            ``(2) Minimum qualifying coverage.--In establishing the 
        criteria described in subsection (a)(1)(B), the Secretary--
                    ``(A) shall--
                            ``(i) exclude from meeting such criteria 
                        any coverage that--
                                    ``(I) provides reimbursement for 
                                the treatment or mitigation of--
                                            ``(aa) a single disease or 
                                        condition; or
                                            ``(bb) an unreasonably 
                                        limited set of diseases or 
                                        conditions; or
                                    ``(II) has an out of pocket limit 
                                that exceeds the amount described in 
                                section 223(c)(2) of the Internal 
                                Revenue Code of 1986 for the year 
                                involved; and
                            ``(ii) establish such criteria (taking into 
                        account the requirements established under 
                        clause (i)) in a manner that results in the 
                        least practicable disruption of the health care 
                        marketplace, consistent with the goals and 
                        activities under this title; and
                    ``(B) may provide for the application of different 
                criteria (except with respect to the limitation 
                described in subparagraph (A)(i)(II)) with respect to 
                young adults.
            ``(3) Affordable coverage.--The Secretary shall establish a 
        standard under which coverage is defined to be unaffordable 
        only if the premium paid by the individual is greater than 12.5 
        percent of the adjusted gross income of the individual 
        involved. Beginning with calendar years after 2013, the 
        Secretary shall adjust the percentage described in this 
        paragraph by an amount that is equal to the percentage increase 
        or decrease in the medical care component of the Consumer Price 
        Index for all urban consumers (U.S. city average) during the 
        preceding calendar year.

``SEC. 3104. ALLOWING STATE FLEXIBILITY.

    ``(a) Optional State Establishment of Gateway.--During the 4-year 
period following the date of enactment of this section, a State may--
            ``(1)(A) establish a Gateway;
            ``(B) adopt the insurance reform provisions as provided for 
        in subtitle A of title I of the Affordable Health Choices Act 
        (and the amendments made by such title); and
            ``(C) agree to make employers that are State or local 
        governments subject to sections 162 and 163 of the Affordable 
        Health Choices Act.
            ``(2)(A) request that the Secretary operate (for a minimum 
        period of 5 years) a Gateway in such State;
            ``(B) adopt the insurance reform provisions as provided for 
        in subtitle A of title I of the Affordable Health Choices Act 
        (and the amendments made by such subtitle); and
            ``(C) agree to make employers that are State or local 
        governments subject to sections 162 and 163 of the Affordable 
        Health Choices Act; or
            ``(3) elect not to take the actions described in paragraph 
        (1) or (2).
    ``(b) Establishing States.--
            ``(1) In general.--If the Secretary determines that a State 
        has taken the actions described in subsection (a)(1), any 
        resident of that State who is an eligible individual shall be 
        eligible for credits under section 3111 beginning on the date 
        that is 60 days after the date of such determination.
            ``(2) Continued review.--The Secretary shall establish 
        procedures to ensure continued review by the Secretary of the 
        compliance of a State with the requirements of subsection (a). 
        If the Secretary determines that a State has failed to maintain 
        compliance with such requirements, the Secretary may revoke the 
        determination under paragraph (1).
            ``(3) Deeming.--A State that is the subject of a positive 
        determination by the Secretary under paragraph (1) (unless such 
        determination is revoked under paragraph (2)) shall be deemed 
        to be an `establishing State' beginning on the date that is 60 
        days after the date of such determination.
    ``(c) Request for the Secretary to Establish a Gateway.--
            ``(1) In general.--In the case of a State that makes the 
        request described in subsection (a)(2), the Secretary shall 
        determine whether the State has enacted and has in effect the 
        insurance reforms provided for in subtitle A of title I of the 
        Affordable Health Choices Act.
            ``(2) Operation of gateway.--
                    ``(A) Positive determination.--If the Secretary 
                determines that the State has enacted and has in effect 
                the insurance reforms described in paragraph (1), the 
                Secretary shall establish a Gateway in such State as 
                soon as practicable after making such determination.
                    ``(B) Negative determination.--If the Secretary 
                determines that the State has not enacted or does not 
                have in effect the insurance reforms described in 
                paragraph (1), the Secretary shall establish a Gateway 
                in such State as soon as practicable after the 
                Secretary determines that such State has enacted and 
                has in effect such reforms.
            ``(3) Participating state.--The State shall be deemed to be 
        a `participating State' on the date on which the Gateway 
        established by the Secretary is in effect in such State.
            ``(4) Eligibility.--Any resident of a State described in 
        paragraph (3) who is an eligible individual shall be eligible 
        for credits under section 3111 beginning on the date that is 60 
        days after the date on which such Gateway is established in 
        such State.
    ``(d) Federal Fallback in the Case of States That Refuse to Improve 
Health Care Coverage.--
            ``(1) In general.--Upon the expiration of the 4-year period 
        following the date of enactment of this section, in the case of 
        a State that is not otherwise a participating State or an 
        establishing State--
                    ``(A) the Secretary shall establish and operate a 
                Gateway in such State;
                    ``(B) the insurance reform provisions provided for 
                in subtitle A of title I of the Affordable Health 
                Choices Act shall become effective in such State, 
                notwithstanding any contrary provision of State law;
                    ``(C) the State shall be deemed to be a 
                `participating State'; and
                    ``(D) the residents of that State who are eligible 
                individuals shall be eligible for credits under section 
                3111 beginning on the date that is 60 days after the 
                date on which such Gateway is established, if the State 
                agrees to make employers that are State or local 
                governments subject to sections 162 and 163 of the 
                Affordable Health Choices Act.
            ``(2) Eligibility of individuals for credits.--With respect 
        to a State that makes the election described in subsection 
        (a)(3), the residents of such State shall not be eligible for 
        credits under section 3111 until such State becomes a 
        participating State under paragraph (1).

``SEC. 3105. NAVIGATORS.

    ``(a) In General.--The Secretary shall award grants to establishing 
or participating States to enable such States (or the Gateways 
operating in such States) to enter into agreements with private and 
public entities under which such entities will serve as navigators in 
accordance with this section.
    ``(b) Eligibility.--
            ``(1) In general.--To be eligible to enter into an 
        agreement under subsection (a), an entity shall demonstrate 
        that the entity has existing relationships with, or could 
        readily establish relationships with, employers and employees, 
        consumers (including the uninsured and the underinsured), or 
        self-employed individuals, likely to be qualified to enroll in 
        a qualified health plan.
            ``(2) Types.--Entities described in paragraph (1) may 
        include trade, industry and professional associations, 
        commercial fishing industry organizations, ranching and farming 
        organizations, community and consumer-focused nonprofit groups, 
        chambers of commerce, unions, small business development 
        centers, other licensed insurance agents and brokers, and other 
        entities that the Secretary determines to be capable of 
        carrying out the duties described in subsection (c).
    ``(c) Duties.--An entity that serves as a navigator under an 
agreement under subsection (a) shall--
            ``(1) conduct public education activities to raise 
        awareness of the program under this title;
            ``(2) distribute fair and impartial information concerning 
        enrollment in qualified health plans, and the availability of 
        credits under section 3111;
            ``(3) facilitate enrollment in a qualified health plan;
            ``(4) provide referrals to the appropriate State agency or 
        agencies for any enrollee with a grievance, complaint, or 
        question regarding their health plan, coverage, or a 
        determination under such plan or coverage; and
            ``(5) provide information in a manner determined by the 
        Secretary to be culturally and linguistically appropriate to 
        the needs of the population served by the Gateway.
    ``(d) Standards.--
            ``(1) In general.--The Secretary shall establish standards 
        for navigators under this section, including provisions to 
        ensure that any private or public entity that is selected as a 
        navigator is qualified, and licensed if appropriate, to engage 
        in the navigator activities described in this section and to 
        avoid conflicts of interest. Under such standards, a navigator 
        shall not--
                    ``(A) be a health insurance issuer; or
                    ``(B) receive any consideration directly or 
                indirectly from any health insurance issuer in 
                connection with the participation of any employer in 
                the program under this title or the enrollment of any 
                qualified individual or qualified employer in a 
                qualified health plan.
            ``(2) Fair and impartial information and services.--The 
        Secretary, in collaboration with States, shall develop 
        guidelines regarding the duties described in subsection (c).

``SEC. 3106. COMMUNITY HEALTH INSURANCE OPTION.

    ``(a) Voluntary Nature.--
            ``(1) No requirement for health care providers to 
        participate.--Nothing in this section shall be construed to 
        require a health care provider to participate in a community 
        health insurance option, or to impose any penalty for non-
        participation.
            ``(2) No requirement for individuals to join.--Nothing in 
        this section shall be construed to require an individual to 
        participate in a community health insurance option, or to 
        impose any penalty for non-participation.
    ``(b) Establishment of Community Health Insurance Option.--
            ``(1) Establishment.--The Secretary shall establish a 
        community health insurance option to offer, through each 
        Gateway established under this title, health care coverage that 
        provides value, choice, competition, and stability of 
        affordable, high quality coverage throughout the United States.
            ``(2) Community health insurance option.--In this section, 
        the term `community health insurance option' means health 
        insurance coverage that--
                    ``(A) except as specifically provided for in this 
                section, complies with the requirements for being a 
                qualified health plan;
                    ``(B) provides high value for the premium charged;
                    ``(C) reduces administrative costs and promotes 
                administrative simplification for beneficiaries;
                    ``(D) promotes high quality clinical care;
                    ``(E) provides high quality customer service to 
                beneficiaries;
                    ``(F) offers a wide choice of providers; and
                    ``(G) complies with State laws (if any), except as 
                otherwise provided for in this title, relating to--
                            ``(i) guaranteed renewal;
                            ``(ii) rating;
                            ``(iii) preexisting conditions;
                            ``(iv) non-discrimination;
                            ``(v) quality improvement and reporting;
                            ``(vi) fraud and abuse;
                            ``(vii) solvency and financial 
                        requirements;
                            ``(viii) market conduct;
                            ``(ix) prompt payment;
                            ``(x) appeals and grievances;
                            ``(xi) privacy and confidentiality;
                            ``(xii) licensure; and
                            ``(xiii) benefit plan material or 
                        information.
            ``(3) Essential health benefits.--
                    ``(A) General rule.--Except as provided in 
                subparagraph (B), a community health insurance option 
                offered under this section shall provide coverage only 
                for the essential health benefits described in section 
                3103.
                    ``(B) States may offer additional benefits.--A 
                State may require that a community health insurance 
                option offered in such State offer benefits in addition 
                to the essential health benefits required under 
                subparagraph (A).
                    ``(C) Credits.--
                            ``(i) In general.--An individual enrolled 
                        in a community health insurance option under 
                        this section shall be eligible for credits 
                        under section 3111 in the same manner as an 
                        individual who is enrolled in a qualified 
                        health plan.
                            ``(ii) No additional federal cost.--A 
                        requirement by a State under subparagraph (B) 
                        that a community health insurance option cover 
                        benefits in addition to the essential health 
                        benefits required under subparagraph (A) shall 
                        not affect the amount of a credit provided 
                        under section 3111 with respect to such plan.
                    ``(D) State must assume cost.--A State shall make 
                payments to or on behalf of an eligible individual to 
                defray the cost of any additional benefits described in 
                subparagraph (B).
                    ``(E) Ensuring access to all services.--Nothing in 
                this Act shall prohibit an individual enrolled in a 
                community health insurance option from paying out-of-
                pocket the full cost of any item or service not 
                included as an essential health benefit or otherwise 
                covered as a benefit by a health plan. Nothing in this 
                Act shall prohibit any type of medical provider from 
                accepting an out-of-pocket payment from an individual 
                enrolled in a community health insurance option for a 
                service otherwise not included as an essential health 
                benefit.
                    ``(F) Protecting access to end of life care.--A 
                community health insurance option offered under this 
                section shall be prohibited from limiting access to end 
                of life care.
            ``(4) Cost sharing.--A community health insurance option 
        shall offer coverage at each of the cost sharing tiers 
        described in section 3111(a).
            ``(5) Premiums.--
                    ``(A) Premiums sufficient to cover costs.--The 
                Secretary shall set premium rates in an amount 
                sufficient to cover expected costs (including claims 
                and administrative costs) using methods in general use 
                by qualified health plans.
                    ``(B) Applicable rules.--The provisions of title 
                XXVII relating to premiums shall apply to community 
                health insurance options under this section, including 
                modified community rating provisions under section 
                2701.
                    ``(C) Collection of data.--The Secretary shall 
                collect data as necessary to set premium rates under 
                subparagraph (A).
                    ``(D) Contingency margin.--In establishing premium 
                rates under subparagraph (A), the Secretary shall 
                include an appropriate amount for a contingency margin.
            ``(6) Reimbursement rates.--
                    ``(A) Negotiated rates.--The Secretary shall 
                negotiate rates for the reimbursement of health care 
                providers for benefits covered under a community health 
                insurance option.
                    ``(B) Limitation.--The rates described in 
                subparagraph (A) shall not be higher, in aggregate, 
                than the average reimbursement rates paid by health 
                insurance issuers offering qualified health plans 
                through the Gateway.
                    ``(C) Innovation.--Subject to the limits contained 
                in subparagraph (A), a State Advisory Council 
                established or designated under subsection (d) may 
                develop or encourage the use of innovative payment 
                policies that promote quality, efficiency and savings 
                to consumers.
                    ``(D) Physician negotiated rates.--Nothing in this 
                paragraph shall prohibit the application of a State law 
                that permits physicians to jointly negotiate with 
                health plans. In such State, physicians may jointly 
                negotiate with a community health insurance option 
                concerning rates paid by the option.
            ``(7) Solvency and consumer protection.--
                    ``(A) Solvency.--The Secretary shall establish a 
                Federal solvency standard to be applied with respect to 
                a community health insurance option. A community health 
                insurance option shall also be subject to the solvency 
                standard of each State in which such community health 
                insurance option is offered.
                    ``(B) Minimum required.--In establishing the 
                standard described under subparagraph (A), the 
                Secretary shall require a reserve fund that shall be 
                equal to at least the dollar value of the incurred but 
                not reported claims of a community health insurance 
                option.
                    ``(C) Consumer protections.--The consumer 
                protection laws of a State shall apply to a community 
                health insurance option.
            ``(8) Requirements established in partnership with 
        insurance commissioners.--
                    ``(A) In general.--The Secretary, in collaboration 
                with the National Association of Insurance 
                Commissioners (in this paragraph referred to as the 
                `NAIC'), may promulgate regulations to establish 
                additional requirements for a community health 
                insurance option.
                    ``(B) Applicability.--Any requirement promulgated 
                under subparagraph (A) shall be applicable to such 
                option beginning 90 days after the date on which the 
                regulation involved becomes final.
            ``(9) Ombudsman.--In establishing community health 
        insurance options, the Secretary shall establish an ombudsman 
        or similar mechanism to provide assistance to consumers with 
        respect to disputes, grievances, or appeals.
    ``(c) Start-up Fund.--
            ``(1) Establishment of fund.--
                    ``(A) In general.--There is established in the 
                Treasury of the United States a trust fund to be known 
                as the `Health Benefit Plan Start-Up Fund' (referred to 
                in this section as the `Start-Up Fund'), that shall 
                consist of such amounts as may be appropriated or 
                credited to the Start-Up Fund as provided for in this 
                subsection to provide loans for the initial operations 
                of a community health insurance option. Such amounts 
                shall remain available until expended.
                    ``(B) Funding.--There is hereby appropriated to the 
                Start-Up Fund, out of any moneys in the Treasury not 
                otherwise appropriated an amount requested by the 
                Secretary of Health and Human Services as necessary 
                to--
                            ``(i) pay the start-up costs associated 
                        with the initial operations of a community 
                        health insurance option;
                            ``(ii) pay the costs of making payments on 
                        claims submitted during the period that is not 
                        more than 90 days from the date on which such 
                        option is offered; and
                            ``(iii) make payments under paragraph (3).
            ``(2) Use of start-up fund.--The Secretary shall use 
        amounts contained in the Start-Up Fund to make payments 
        (subject to the repayment requirements in paragraph (5)) for 
        the purposes described in paragraph (1)(B).
            ``(3) Risk corridor payments.--
                    ``(A) In general.--In any case in which the 
                Secretary has entered into a contract with a 
                contracting administrator, the Secretary shall use 
                amounts contained in the Start-Up Fund to make risk 
                corridor payments to such administrator during the 2-
                year period beginning on the date on which such 
                administrator enters into a contract under subsection 
                (e). Such payments shall be based on the risk corridors 
                in effect during fiscal years 2006 and 2007 for making 
                payments under section 1860D-15(e) of the Social 
                Security Act.
                    ``(B) Subsequent year.--In years after the 
                expiration of the period referred to in subparagraph 
                (A), the Secretary may extend or increase the risk 
                corridors and payments provided for under subparagraph 
                (A).
                    ``(C) Amount used to reduce costs.--The Secretary 
                shall deposit any payments received from a contracting 
                administrator under subparagraph (A) into the Start-Up 
                Fund.
            ``(4) Pass through of rebates.--The Secretary may establish 
        procedures for reducing the amount of payments to a contracting 
        administrator to take into account any rebates or price 
        concessions.
            ``(5) Repayment.--
                    ``(A) In general.--A community health insurance 
                option shall be required to repay the Secretary of the 
                Treasury (on such terms as the Secretary may require) 
                for any payments made under paragraph (1)(B) by the 
                date that is not later than 10 years after the date on 
                which the payment is made. The Secretary may require 
                the payment of interest with respect to such repayments 
                at rates that do not exceed the market interest rate 
                (as determined by the Secretary).
                    ``(B) Sanctions in case of for-profit conversion.--
                In any case in which the Secretary enters into a 
                contract with a qualified entity for the offering of a 
                community health insurance option and such entity is 
                determined to be a for-profit entity by the Secretary, 
                such entity shall be--
                            ``(i) immediately liable to the Secretary 
                        for any payments received by such entity from 
                        the Start-Up Fund; and
                            ``(ii) permanently ineligible to offer a 
                        qualified health plan.
    ``(d) State Advisory Council.--
            ``(1) Establishment.--A State shall establish or designate 
        a public or non-profit private entity to serve as the State 
        Advisory Council to provide recommendations to the Secretary on 
        the operations and policies of a community health insurance 
        option in the State. Such Council shall provide recommendations 
        on at least the following:
                    ``(A) policies and procedures to integrate quality 
                improvement and cost containment mechanisms into the 
                health care delivery system;
                    ``(B) mechanisms to facilitate public awareness of 
                the availability of a community health insurance 
                option; and
                    ``(C) alternative payment structures under a 
                community health insurance option for health care 
                providers that encourage quality improvement and cost 
                control.
            ``(2) Members.--The members of the State Advisory Council 
        shall be representatives of the public and shall include 
        educated health care consumers and providers.
            ``(3) Applicability of recommendations.--The Secretary may 
        apply the recommendations of a State Advisory Council to a 
        community health insurance option that State, in any other 
        State, or in all States.
    ``(e) Authority to Contract; Terms of Contract.--
            ``(1) Authority.--
                    ``(A) In general.--The Secretary may enter into a 
                contract or contracts with one or more qualified 
                entities for the purpose of performing administrative 
                functions (including functions described in subsection 
                (a)(4) of section 1874A of the Social Security Act) 
                with respect to a community health insurance option in 
                the same manner as the Secretary may enter into 
                contracts under subsection (a)(1) of such section. The 
                Secretary shall have the same authority with respect to 
                a community health insurance option under this section 
                as the Secretary has under subsections (a)(1) and (b) 
                of section 1874A of the Social Security Act with 
                respect to title XVIII of such Act.
                    ``(B) Requirements apply.--If the Secretary enters 
                into a contract with a qualified entity to offer a 
                community health insurance option, under such contract 
                such entity--
                            ``(i) shall meet the criteria established 
                        under paragraph (2); and
                            ``(ii) shall receive an administrative fee 
                        under paragraph (7).
                    ``(C) Limitation.--Contracts under this subsection 
                shall not involve the transfer of insurance risk to the 
                contracting administrator.
                    ``(D) Reference.--An entity with which the 
                Secretary has entered into a contract under this 
                paragraph shall be referred to as a `contracting 
                administrator'.
            ``(2) Qualified entity.--To be qualified to be selected by 
        the Secretary to offer a community health insurance option, an 
        entity shall--
                    ``(A) meet the criteria established under section 
                1874A(a)(2) of the Social Security Act;
                    ``(B) be a nonprofit entity for purposes of 
                offering such option;
                    ``(C) meet the solvency standards applicable under 
                subsection (b)(7);
                    ``(D) be eligible to offer health insurance or 
                health benefits coverage;
                    ``(E) meet quality standards specified by the 
                Secretary;
                    ``(F) have in place effective procedures to control 
                fraud, abuse, and waste; and
                    ``(G) meet such other requirements as the Secretary 
                may impose.
        ``Procedures described under subparagraph (F) shall include the 
        implementation of procedures to use beneficiary identifiers to 
        identify individuals entitled to benefits so that such an 
        individual's social security account number is not used, and 
        shall also include procedures for the use of technology 
        (including front-end, prepayment intelligent data-matching 
        technology similar to that used by hedge funds, investment 
        funds, and banks) to provide real-time data analysis of claims 
        for payment under this title to identify and investigate 
        unusual billing or order practices under this title that could 
        indicate fraud or abuse.
            ``(3) Term.--A contract provided for under paragraph (1) 
        shall be for a term of at least 5 years but not more than 10 
        years, as determined by the Secretary. At the end of each such 
        term, the Secretary shall conduct a competitive bidding process 
        for the purposes of renewing existing contracts or selecting 
        new qualified entities with which to enter into contracts under 
        such paragraph.
            ``(4) Limitation.--A contract may not be renewed under this 
        subsection unless the Secretary determines that the contracting 
        administrator has met performance requirements established by 
        the Secretary in the areas described in paragraph (7)(B).
            ``(5) Audits.--The Inspector General shall conduct periodic 
        audits with respect to contracting administrators under this 
        subsection to ensure that the administrator involved is in 
        compliance with this section.
            ``(6) Revocation.--A contract awarded under this subsection 
        shall be revoked by the Secretary or the Inspector General only 
        after notice to the contracting administrator involved and an 
        opportunity for a hearing. The Secretary may revoke such 
        contract if the Secretary determines that such administrator 
        has engaged in fraud, deception, waste, abuse of power, 
        negligence, mismanagement of taxpayer dollars, or gross 
        mismanagement. An entity that has had a contract revoked under 
        this paragraph shall not be qualified to enter into a 
        subsequent contract under this subsection.
            ``(7) Fee for administration.--
                    ``(A) In general.--The Secretary shall pay the 
                contracting administrator a fee for the management, 
                administration, and delivery of the benefits under this 
                section.
                    ``(B) Requirement for high quality 
                administration.--The Secretary may increase the fee 
                described in subparagraph (A) by not more than 10 
                percent, or reduce the fee described in subparagraph 
                (A) by not more than 50 percent, based on the extent to 
                which the contracting administrator, in the 
                determination of the Secretary, meets performance 
                requirements established by the Secretary, in at least 
                the following areas:
                            ``(i) Maintaining low premium costs and low 
                        cost sharing requirements, provided that such 
                        requirements are consistent with section 
                        3111(a).
                            ``(ii) Reducing administrative costs and 
                        promoting administrative simplification for 
                        beneficiaries.
                            ``(iii) Promoting high quality clinical 
                        care.
                            ``(iv) Providing high quality customer 
                        service to beneficiaries.
                    ``(C) Non-renewal.--The Secretary may not renew a 
                contract to offer a community health insurance option 
                under this section with any contracting entity that has 
                been assessed more than one reduction under 
                subparagraph (B) during the contract period.
            ``(8) Limitation.--Notwithstanding the terms of a contract 
        under this subsection, the Secretary shall negotiate the 
        reimbursement rates for purposes of subsection (b)(6).
    ``(f) Report by HHS and Insolvency Warnings.--
            ``(1) In general.--On an annual basis, the Secretary shall 
        conduct a study on the solvency of a community health insurance 
        option and submit to Congress a report describing the results 
        of such study.
            ``(2) Result.--If, in any year, the result of the study 
        under paragraph (1) is that a community health insurance option 
        is insolvent, such result shall be treated as a community 
        health insurance option solvency warning.
            ``(3) Submission of plan and procedure.--
                    ``(A) In general.--If there is a community health 
                insurance option solvency warning under paragraph (2) 
                made in a year, the President shall submit to Congress, 
                within the 15-day period beginning on the date of the 
                budget submission to Congress under section 1105(a) of 
                title 31, United States Code, for the succeeding year, 
                proposed legislation to respond to such warning.
                    ``(B) Procedure.--In the case of a legislative 
                proposal submitted by the President pursuant to 
                subparagraph (A), such proposal shall be considered by 
                Congress using the same procedures described under 
                sections 803 and 804 of the Medicare Prescription Drug, 
                Improvement, and Modernization Act of 2003 that shall 
                be used for a medicare funding warning.
    ``(g) Marketing Parity.--In a facility controlled by the Federal 
Government, or by a State, where marketing or promotional materials 
related to a community health insurance option are made available to 
the public, making available marketing or promotional materials 
relating to private health insurance plans shall not be prohibited. 
Such materials include informational pamphlets, guidebooks, enrollment 
forms, or other materials determined reasonable for display.
    ``(h) Authorization of Appropriations.--There is authorized to be 
appropriated, such sums as may be necessary to carry out this section.

``SEC. 3107. APPLICATION OF SAME LAWS TO PRIVATE PLANS AND THE 
              COMMUNITY HEALTH INSURANCE OPTION.

    ``(a) In General.--Notwithstanding any other provision of law, any 
health insurance coverage offered by a private health insurance issuer 
shall not be subject to any Federal or State law described in 
subsection (b) if a community health insurance option under section 
3106 is not subject to such law.
    ``(b) Laws Described.--The Federal and State laws described in this 
subsection are those Federal and State laws relating to--
            ``(1) guaranteed renewal;
            ``(2) rating;
            ``(3) preexisting conditions;
            ``(4) non-discrimination;
            ``(5) quality improvement and reporting;
            ``(6) fraud and abuse;
            ``(7) solvency and financial requirements;
            ``(8) market conduct;
            ``(9) prompt payment;
            ``(10) appeals and grievances;
            ``(11) privacy and confidentiality;
            ``(12) licensure; and
            ``(13) benefit plan material or information.

``SEC. 3108. PARTICIPATION OF PROFESSIONALS ON CERTAIN HEALTH-RELATED 
              COMMISSIONS.

    ``The membership of any council, committee, or other advisory body 
which the Secretary uses to inform official decision-making related to 
coverage of, or payment for, medical procedures, conditions, or care, 
shall have as its participants professionals who hold medical degrees 
from accredited American universities or colleges and have active 
clinical practice. Such advisory entities shall be composed of not less 
than one-third of such professionals.

``SEC. 3109. HEALTH INSURANCE CONSUMER ASSISTANCE GRANTS.

    ``(a) In General.--The Secretary shall award grants to establishing 
or participating States to enable such States (or the Gateways 
operating in such States) to establish, expand, or provide support for 
offices of health insurance consumer assistance.
    ``(b) Eligibility.--
            ``(1) In general.--To be eligible to receive a grant, a 
        State shall designate an office of health insurance consumer 
        assistance that, directly or in coordination with State health 
        insurance regulators and consumer assistance organizations, 
        receives and responds to inquiries and complaints concerning 
        health insurance coverage with respect to Federal health 
        insurance requirements and under State law.
            ``(2) Criteria.--A State that receives a grant under this 
        section shall comply with criteria established by the Secretary 
        for carrying out activities under such grant.
    ``(c) Duties.--The State-designated office of health insurance 
consumer assistance shall--
            ``(1) assist with the filing of complaints and appeals, 
        including filing appeals with a qualified health plan's 
        internal appeal or grievance process and providing information 
        about the external appeal process;
            ``(2) track consumer complaints, quantify such complaints, 
        and regularly report such complaints to the State Gateway or 
        the Secretary, as necessary;
            ``(3) educate consumers on their rights and 
        responsibilities with respect to qualified health plans; and
            ``(4) assist consumers with enrollment in a qualified 
        health plan by providing information, referral, and assistance, 
        in collaboration with navigators under section 3105.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $20,000,000 for fiscal year 
2010, and such sums as may be necessary for each fiscal year 
thereafter.''.

SEC. 143. FREEDOM NOT TO PARTICIPATE IN FEDERAL HEALTH INSURANCE 
              PROGRAMS.

    (a) Requirement.--Notwithstanding any other provision of law, on 
the date of enactment of this Act, all Members of Congress and 
congressional staff shall enroll in a Federal health insurance 
program--
            (1) created under this Act (or an amendment made by this 
        Act); or
            (2) offered through a Gateway established under this Act 
        (or an amendment made by this Act).
    (b) Definitions.--In this section:
            (1) Member of congress.--The term ``Member of Congress'' 
        means any member of the House of Representatives or the Senate.
            (2) Congressional staff.--The term ``congressional staff'' 
        means all full-time and part-time employees employed by the 
        official office of a Member of Congress, whether in Washington, 
        DC or outside of Washington, DC.

           Subtitle C--Affordable Coverage for All Americans

SEC. 151. SUPPORT FOR AFFORDABLE HEALTH COVERAGE.

    (a) In General.--Title XXXI of the Public Health Service Act, as 
added by section 142(a), is amended by inserting after subtitle A the 
following:

                ``Subtitle B--Making Coverage Affordable

``SEC. 3111. SUPPORT FOR AFFORDABLE HEALTH COVERAGE.

    ``(a) Cost Sharing for a Basic Plan.--
            ``(1) Basic plan.--The Secretary shall establish at least 
        the following tiers of cost sharing for eligible individuals:
                    ``(A) A tier for a basic plan in which--
                            ``(i) a qualified health plan shall, on 
                        average, provide reimbursement for 76 percent 
                        of the total allowed costs of the benefit 
                        provided; and
                            ``(ii) the out of pocket limitation for the 
                        plan shall not be greater than the out of 
                        pocket limitation applicable under section 
                        223(c)(2) of the Internal Revenue Code of 1986.
                    ``(B) A tier in which--
                            ``(i) the average reimbursement percentage 
                        is equal to the reimbursement percentage of the 
                        basic plan increased by 8 percentage points; 
                        and
                            ``(ii) the dollar value of the out of 
                        pocket limitation shall not be greater than 50 
                        percent of the dollar value of the out of 
                        pocket limitation of the basic plan.
                    ``(C) A tier in which--
                            ``(i) the average reimbursement percentage 
                        is equal to the reimbursement percentage of the 
                        basic plan increased by 17 percentage points; 
                        and
                            ``(ii) the dollar value of the out of 
                        pocket limitation shall not be greater than 20 
                        percent of the dollar value of the out of 
                        pocket limitation of the basic plan.
            ``(2) Out of pocket.--For purposes of this section, the 
        term `out of pocket' shall include all expenditures for covered 
        qualified medical expenses (as provided for with respect to 
        high deductible health plans under section 223(d)(2) of the 
        Internal Revenue Code of 1986).
    ``(b) Payment of Credits.--
            ``(1) In general.--The Secretary shall, with respect to an 
        eligible individual (as defined in section 3116(a)(1)) and on 
        behalf of such individual, pay a premium credit to the Gateway 
        through which the individual is enrolled in the qualified 
        health plan involved. Such Gateway shall remit an amount equal 
        to such credit to the qualified health plan in which such 
        individual is enrolled.
            ``(2) Amount.--
                    ``(A) In general.--Subject to the indexing 
                provision described in paragraph (6), and the 
                limitation described in paragraph (4), the amount of an 
                annual credit with respect to an eligible individual 
                under paragraph (1) shall be an amount determined by 
                the Secretary so that the eligible individual involved 
                is not required to pay in the case of an individual 
                with an adjusted gross income equal to 400 percent of 
                the poverty line for a family of the size involved, an 
                amount that exceeds 12.5 percent of such individual's 
                income for the year involved.
                    ``(B) Reductions based on income.--The amount that 
                an eligible individual is required to pay under 
                subparagraph (A) shall be ratably reduced to 1 percent 
                of income in the case of an eligible individual with an 
                adjusted gross income equal to 150 percent of the 
                poverty line for a family of the size involved for the 
                year.
            ``(3) Simplified schedule.--The Secretary may establish a 
        schedule of premium credits under this subsection in dollar 
        amounts to simplify the administration of this section so long 
        as any such schedule does not significantly change the value of 
        the premium credits described in paragraph (2).
            ``(4) Limitation of credits.--
                    ``(A) In general.--A credit under paragraph (1) may 
                not exceed the lesser of the amount of the reference 
                premium for the individual involved or the premium of 
                the qualified health plan in which such individual is 
                enrolled.
                    ``(B) Reference premium.--In this section, the term 
                `reference premium' means--
                            ``(i) with respect to an individual 
                        enrolling in coverage whose adjusted gross 
                        income does not exceed 200 percent of the 
                        poverty line for a family of the size involved 
                        for the year, the weighted average annual 
                        premium of the 3 lowest cost qualified health 
                        plans that--
                                    ``(I) meet the criteria for cost 
                                sharing and out of pocket limits 
                                described in subsection (a)(1)(C); and
                                    ``(II) are offered in the community 
                                rating area in which the individual 
                                resides;
                            ``(ii) with respect to an individual 
                        enrolling in coverage whose adjusted gross 
                        income exceeds 200, but does not exceed 300, 
                        percent of the poverty line for a family of the 
                        size involved for the year, the weighted 
                        average annual premium of the 3 lowest cost 
                        qualified health plans that--
                                    ``(I) meet the criteria for cost 
                                sharing and out of pocket limits 
                                described in subsection (a)(1)(B); and
                                    ``(II) are offered in the community 
                                rating area in which the individual 
                                resides; and
                            ``(iii) with respect to an individual 
                        enrolling in coverage whose adjusted gross 
                        income exceeds 300, but does not exceed 400, 
                        percent of the poverty line for a family of the 
                        size involved for the year, the weighted 
                        average annual premium of the 3 lowest cost 
                        qualified health plans that--
                                    ``(I) meet the criteria for cost 
                                sharing and out of pocket limits 
                                described in subsection (a)(1)(A); and
                                    ``(II) are offered in the community 
                                rating area in which the individual 
                                resides.
                    ``(C) Individuals allowed to enroll in any plan.--
                Nothing in this section shall be construed to prohibit 
                a qualified individual from enrolling in any qualified 
                health plan.
                    ``(D) Limitation.--In determining the 3 lowest cost 
                health plans for purposes of this paragraph, the 
                community health insurance option shall not be 
                considered.
            ``(5) Method of calculation.--
                    ``(A) Calculation of credit based on essential 
                health care benefits.--In the case of a qualified 
                health plan that provides reimbursement for benefits 
                that are not included in the essential health benefits 
                established by the Secretary under section 
                3103(a)(1)(A), the reference premium shall be 
                determined for purposes of paragraph (2) without regard 
                to such reimbursement.
                    ``(B) Risk adjustment.--The reference premium shall 
                be adjusted to account for premium differences based on 
                age, family size, and geographic variation.
                    ``(C) Rule in case of fewer plans.--In any case in 
                which there are less than 3 qualified health plans 
                offered in the community rating area in which the 
                individual resides, the determinations made under 
                paragraph (2) shall be based on the number of such 
                qualified plans that are actually offered in the area.
            ``(6) Indexing.--Beginning with calendar years after 2013, 
        the percentages described in paragraph (2) that specify the 
        portion of the reference premium that an individual or family 
        is responsible for paying shall be annually adjusted by a 
        percentage that is equal to the percentage increase or decrease 
        in the medical care component of the Consumer Price Index for 
        all urban consumers (U.S. city average) during the preceding 
        calendar year.
    ``(c) State Flexibility.--A State may make payments to or on behalf 
of an eligible individual that are greater than the amounts required 
under this section.
    ``(d) Eligibility Determinations.--
            ``(1) Rule for eligibility determinations.--The Secretary 
        shall, by regulation, establish rules and procedures for--
                    ``(A) the submission of applications during the 
                fourth quarter of the calendar year involved for 
                payments under this section, including the electronic 
                submission of documents necessary for application and 
                enrollment;
                    ``(B) making determinations with respect to the 
                eligibility of individuals submitting applications 
                under subparagraph (A) for payments under this section 
                and informing individuals of such determinations, 
                including verifying income through the use of data 
                contained in the tax returns of applicants for such 
                credits;
                    ``(C) making determinations of adjusted gross 
                income in cases where the individual applicant was not 
                required to file a tax return for the taxable year 
                involved;
                    ``(D) resolving appeals of such determinations;
                    ``(E) redetermining eligibility on a periodic 
                basis; and
                    ``(F) making payments under this section.
            ``(2) Determination of eligibility.--For purposes of 
        paragraph (1), the Secretary shall establish rules that permit 
        eligibility to be determined based on--
                    ``(A) the applicant's adjusted gross income for the 
                second preceding taxable year; or
                    ``(B) in the case of an individual who is seeking 
                payment under this section based on claiming a 
                significant decrease in adjusted gross income--
                            ``(i) the applicant's adjusted gross income 
                        for the most recent period otherwise 
                        practicable; or
                            ``(ii) the applicant's declaration of 
                        estimated annual adjusted gross income for the 
                        year involved.
            ``(3) Determining eligibility.--
                    ``(A) Authority of the secretary.--
                            ``(i) In general.--The Secretary shall have 
                        the authority to make determinations (including 
                        redeterminations) with respect to the 
                        eligibility of individuals submitting 
                        applications for credits under this section. 
                        The Secretary shall verify, through the 
                        Internal Revenue Service or using the income 
                        and eligibility verification system utilized 
                        for purposes of the Medicaid program under 
                        section 1137 of the Social Security Act, the 
                        income data received from individuals 
                        submitting applications for credits under this 
                        section.
                            ``(ii) Authority to use tax returns.--To be 
                        eligible to receive a credit under this 
                        section, an individual shall--
                                    ``(I) authorize the disclosure of 
                                the tax return information of the 
                                individual as provided for in section 
                                6103(l)(21) of the Internal Revenue 
                                Code; or
                                    ``(II) with respect to individuals 
                                who do not file a tax return for the 
                                year involved--
                                            ``(aa) provide satisfactory 
                                        documentation of adjusted gross 
                                        income, as determined by the 
                                        Secretary, which may include a 
                                        prior year Federal income tax 
                                        return; and
                                            ``(bb) authorize the 
                                        disclosure to the Secretary of 
                                        such information as may be 
                                        required from the Internal 
                                        Revenue Service to verify that 
                                        such individual has not filed a 
                                        tax return for the year 
                                        involved.
                            ``(iii) Stringency.--The verification 
                        requirements with respect to individuals 
                        described in clause (ii)(II) shall be at least 
                        as stringent as those required under section 
                        1137 of the Social Security Act.
                    ``(B) Delegation of authority.--Except under the 
                conditions described in subparagraph (D), the Secretary 
                shall delegate to a Gateway (and, upon request from 
                such State or States, to the State or States in which 
                such Gateway operates) the authority to carry out the 
                activities described in subparagraph (A). The Gateway 
                may consult with the Internal Revenue Service to verify 
                income data received from individuals submitting 
                applications for credits under this section.
                    ``(C) Requirement for consistency.--A Gateway (and, 
                as applicable, the State or States in which such 
                Gateway operates) shall carry out the activities 
                described in subparagraph (B) in a manner that is 
                consistent with the regulations promulgated under 
                paragraph (1).
                    ``(D) Revocation of authority.--If the Secretary 
                determines that a Gateway (or the State or States in 
                which such Gateway operates) is carrying out the 
                activities described in subparagraph (A) in a manner 
                that is substantially inconsistent with the regulations 
                promulgated under paragraph (1), the Secretary may, 
                after notice and opportunity for a hearing, revoke the 
                delegation of authority under subparagraph (A). If the 
                Secretary revokes the delegation of authority, the 
                references to a Gateway in subparagraph (E) and (F) 
                shall be deemed to be references to the Secretary.
                    ``(E) Requirement to report change in status.--
                            ``(i) In general.--An individual who has 
                        been determined to be eligible for credits 
                        under this section shall notify the Gateway of 
                        any changes that may affect such eligibility in 
                        a manner specified by the Secretary.
                            ``(ii) Redetermination.--If the Gateway 
                        receives a notice from an individual under 
                        clause (i), the Gateway shall promptly 
                        redetermine the individual's eligibility for 
                        payments.
                    ``(F) Termination of payments.--The Gateway shall 
                terminate payments on behalf of an individual (after 
                providing notice to the individual) if--
                            ``(i) the individual fails to provide 
                        information for purposes of subparagraph (E)(i) 
                        on a timely basis; or
                            ``(ii) the Gateway determines that the 
                        individual is no longer eligible for such 
                        payments.
                    ``(G) Territorial tax authorities.--With respect to 
                determinations of eligibility for, or payment of, 
                credits under this section that require the use of 
                information maintained by a tax authority of a United 
                States territory, the Secretary shall make such 
                determination in coordination with such authority under 
                rules and procedures that are similar to the rules and 
                procedures applied to determinations made where such 
                information is obtained from the Internal Revenue 
                Service.
            ``(4) Application.--
                    ``(A) Methods.--The process established under 
                paragraph (1)(A) shall permit applications in person, 
                by mail, telephone, or the Internet.
                    ``(B) Form and contents.--An application under 
                paragraph (1)(A) shall be in such form and manner as 
                specified by the Secretary, and may require 
                documentation.
                    ``(C) Submission.--An application under paragraph 
                (1)(A) may be submitted to the Gateway, or to a State 
                agency for a determination under this section.
                    ``(D) Assistance.--A Gateway, or a State agency 
                under this section, shall assist individuals in the 
                filing of applications under paragraph (1)(A).
            ``(5) Reconciliation.--
                    ``(A) Filing of statement.--In the case of an 
                individual who has received payments under this section 
                for a year and who is claiming a significant decrease 
                (as determined by the Secretary) in adjusted gross 
                income from such year, such individual shall file with 
                the Secretary an income reconciliation statement, at 
                such time, in such manner, and containing such 
                information as the Secretary may require.
                    ``(B) Reconciliation.--
                            ``(i) In general.--Based on and using the 
                        adjusted gross income reported in the statement 
                        filed by an individual under subparagraph (A), 
                        the Secretary shall compute the amount of 
                        payments that should have been provided on 
                        behalf of the individual for the year involved.
                            ``(ii) Overpayment of payments.--
                                    ``(I) In general.--Subject to the 
                                limitation in subclause (II), if the 
                                amount of payments provided on behalf 
                                of an individual for a year under this 
                                section was significantly greater (as 
                                determined by the Secretary) than the 
                                amount computed under clause (i), the 
                                individual shall be liable to the 
                                Secretary for such excess amount. The 
                                Secretary may establish methods under 
                                which such liability may be assessed 
                                through a reduction in the amount of 
                                any credit otherwise applicable under 
                                this section with respect to such 
                                individual.
                                    ``(II) Limitation.--With respect to 
                                any individual described in subclause 
                                (I) who had a verified adjusted gross 
                                income that did not exceed 400 percent 
                                of the poverty line for a family of the 
                                size involved for such year, the amount 
                                of any repayment under such subclause 
                                (I) shall not exceed--
                                            ``(aa) $250 for an 
                                        individual who filed an 
                                        individual tax return for such 
                                        year; or
                                            ``(bb) $400 for an 
                                        individual who filed a joint 
                                        tax return for such year.
                                Any such individual with a adjusted 
                                gross income that exceeds 400 percent 
                                of the poverty line for a family of the 
                                size involved for such year shall repay 
                                the entire amount so received.
                            ``(iii) Underpayment of payments.--If the 
                        amount of payments provided to an individual 
                        for a year under this section was less than the 
                        amount computed under clause (i), the Secretary 
                        shall pay to the individual the amount of such 
                        deficit. The Secretary may establish methods 
                        under which such payments may be provided 
                        through an increase in the amount of any credit 
                        otherwise applicable under this section with 
                        respect to such individual.
                            ``(iv) Coordination with irs.--The 
                        Secretary shall coordinate with the Secretary 
                        of the Treasury to develop procedures to enable 
                        the Internal Revenue Service to administer this 
                        subparagraph with respect to the collection of 
                        overpayments.
                    ``(C) Failure to file.--In the case of an 
                individual who fails to file a statement for a year as 
                required under subparagraph (A), the individual shall 
                not be eligible for further payments until such 
                statement is filed. The Secretary shall waive the 
                application of this subparagraph if the individual 
                establishes, to the satisfaction of the Secretary, good 
                cause for the failure to file the statement on a timely 
                basis.
                    ``(D) Determinations.--The Secretary shall make 
                determinations with respect to statements submitted 
                under this paragraph based on income data from the most 
                recent tax return filed by the individual.
            ``(6) Determinations made with respect to same taxable 
        years.--In making determinations under this section with 
        respect to adjusted gross income as compared to the poverty 
        line, the Secretary shall ensure that the poverty line data 
        used relates to the same taxable year for which the adjusted 
        gross income is determined.
            ``(7) Outreach.--The Gateway shall conduct culturally and 
        linguistically appropriate outreach activities to provide 
        information to individuals that may potentially be eligible for 
        payments under this section. Such activities shall include 
        information on the application process with respect to such 
        payments.
    ``(e) Exclusion From Income.--Amounts received by an individual 
under this section shall not be considered as income, and shall not be 
taken into account in determining assets or resources for purposes of 
determining the eligibility of such individual, or any other 
individual, for benefits or assistance, or the amount or extent of 
benefits or assistance, under any Federal program or under any State or 
local program financed in whole or in part with Federal funds.
    ``(f) Conflict.--A Gateway may not establish rules that conflict 
with or prevent the application of regulations promulgated by the 
Secretary under this title.
    ``(g) No Federal Funding.--Nothing in this title shall allow 
Federal payments for individuals who are not lawfully present in the 
United States.
    ``(h) Appropriation.--Out of any funds in the Treasury of the 
United States not otherwise appropriated, there are appropriated such 
sums as may be necessary to carry out this section for each fiscal 
year.

``SEC. 3112. SMALL BUSINESS HEALTH OPTIONS PROGRAM CREDIT.

    ``(a) Calculation of Credit.--For each calendar year beginning in 
calendar year 2010, in the case of an employer that is a qualified 
small employer, out of any funds in the Treasury of the United States 
not otherwise appropriated, the Secretary shall make a payment to such 
qualified small employer in the amount described in subsection (b).
    ``(b) General Credit Amount.--For purposes of this section:
            ``(1) In general.--The credit amount described in this 
        subsection shall be the product of--
                    ``(A) the applicable amount specified in paragraph 
                (2);
                    ``(B) the employer size factor specified in 
                paragraph (3); and
                    ``(C) the percentage of year factor specified in 
                paragraph (4).
            ``(2) Applicable amount.--For purposes of paragraph (1):
                    ``(A) In general.--The applicable amount shall be 
                equal to--
                            ``(i) $1,000 for each employee of the 
                        employer who receives self-only health 
                        insurance coverage through the employer;
                            ``(ii) $2,000 for each employee of the 
                        employer who receives family health insurance 
                        coverage through the employer; and
                            ``(iii) $1,500 for each employee of the 
                        employer who receives health insurance coverage 
                        for two adults or one adult and one or more 
                        children through the employer.
                    ``(B) Bonus for payment of greater percentage of 
                premiums.--The applicable amount specified in 
                subparagraph (A) shall be increased by $200 in the case 
                of subparagraph (A)(i), $400 in the case of 
                subparagraph (A)(ii), and $300 in the case of 
                subparagraph (A)(iii), for each additional 10 percent 
                of the qualified employee health insurance expenses 
                exceeding 60 percent which are paid by the qualified 
                small employer.
            ``(3) Employer size factor.--For purposes of paragraph (1), 
        the employer size factor shall be the percentage determined in 
        accordance with the following:
                    ``(A) With respect to an employer with 10 or fewer 
                employees, the percentage shall be 100 percent.
                    ``(B) With respect to an employer with more than 
                10, but not more than 20, full-time employees, the 
                percentage shall be 80 percent.
                    ``(C) With respect to an employer with more than 
                20, but not more than 30, full-time employees, the 
                percentage shall be 50 percent.
                    ``(D) With respect to an employer with more than 
                30, but not more than 40, full-time employees, the 
                percentage shall be 40 percent.
                    ``(E) With respect to an employer with more than 
                40, but not more than 50, full-time employees, the 
                percentage shall be 20 percent.
                    ``(F) With respect to an employer with more than 50 
                full-time employees, the percentage shall be 0 percent.
            ``(4) Percentage of year factor.--For purposes of paragraph 
        (1), the percentage of year factor shall be equal to the ratio 
        of--
                    ``(A) the number of months during the year for 
                which the employer paid or incurred at least 60 percent 
                of the qualified employee health insurance expenses of 
                such employer; and
                    ``(B) 12.
    ``(c) Definitions and Special Rules.--For purposes of this section:
            ``(1) Qualified small employer.--
                    ``(A) In general.--The term `qualified small 
                employer' means an employer (as defined in section 3(d) 
                of the Fair Labor Standards Act of 1938 and including 
                self-employed individuals) that--
                            ``(i) pays or incurs at least 60 percent of 
                        the qualified employee health insurance 
                        expenses of such employer, or who is self-
                        employed; and
                            ``(ii) was--
                                    ``(I) an employer that--
                                            ``(aa) employed an average 
                                        of 50 or fewer full-time 
                                        employees during the preceding 
                                        taxable year; and
                                            ``(bb) had an average wage 
                                        of less than $50,000 for full 
                                        time employees in the preceding 
                                        taxable year; or
                                    ``(II) a self-employed individual 
                                that--
                                            ``(aa) had not less than 
                                        $5,000 in net earnings;
                                            ``(bb) had not greater than 
                                        $50,000 in net earnings; and
                                            ``(cc) has elected not to 
                                        receive a credit under section 
                                        3111.
                    ``(B) Limitation.--An employer may not receive a 
                credit under this section for more than 1 period of not 
                more than 3 consecutive years.
            ``(2) Qualified employee health insurance expenses.--
                    ``(A) In general.--The term `qualified employee 
                health insurance expenses' means any amount paid by an 
                employer or an employee of such employer for health 
                insurance coverage to the extent such amount is for 
                coverage--
                            ``(i) provided to any employee (as defined 
                        in section 3(e) of the Fair Labor Standards Act 
                        of 1938), or
                            ``(ii) for a self-employed individual.
                    ``(B) Exception for amounts paid under salary 
                reduction arrangements.--No amount paid or incurred for 
                health insurance coverage pursuant to a salary 
                reduction arrangement shall be taken into account for 
                purposes of subparagraph (A).
            ``(3) Full-time employee.--The term `full time employee' 
        means, with respect to any period, an employee (as defined in 
        section 3(e) of the Fair Labor Standards Act of 1938) of an 
        employer if the average number of hours worked by such employee 
        in the preceding taxable year for such employer was at least 40 
        hours per week.
    ``(d) Inflation Adjustment.--
            ``(1) In general.--For each calendar year after 2010, the 
        dollar amounts specified in subsections (b)(2)(A), (b)(2)(B), 
        and (c)(1)(A)(ii) (after the application of this paragraph) 
        shall be the amounts in effect in the preceding calendar year 
        or, if greater, the product of--
                    ``(A) the corresponding dollar amount specified in 
                such subsection; and
                    ``(B) the ratio of the index of wage inflation (as 
                determined by the Bureau of Labor Statistics) for 
                August of the preceding calendar year to such index of 
                wage inflation for August of 2008.
            ``(2) Rounding.--If any amount determined under paragraph 
        (1) is not a multiple of $100, such amount shall be rounded to 
        the next lowest multiple of $100.
    ``(e) Application of Certain Rules in Determination of Employer 
Size.--For purposes of this section:
            ``(1) Application of aggregation rule for employers.--All 
        persons treated as a single employer under subsection (b), (c), 
        (m), or (o) of section 414 of the Internal Revenue Code of 1986 
        shall be treated as 1 employer.
            ``(2) Employers not in existence in preceding year.--In the 
        case of an employer which was not in existence for the full 
        preceding taxable year, the determination of whether such 
        employer meets the requirements of this section shall be based 
        on the average number of full-time employees that it is 
        reasonably expected such employer will employ on business days 
        in the employer's first full taxable year.
            ``(3) Predecessors.--Any reference in this subsection to an 
        employer shall include a reference to any predecessor of such 
        employer.''.

SEC. 152. PROGRAM INTEGRITY.

    (a) In General.--Subsection (l) of section 6103 of the Internal 
Revenue Code of 1986 is amended by adding at the end the following new 
paragraph:
            ``(21) Voluntary authorization for income verification.--
                    ``(A) Voluntary authorization.--The Secretary shall 
                provide a mechanism for each taxpayer to indicate 
                whether such taxpayer authorizes the Secretary to 
                disclose to the Secretary of Health and Human Services 
                (or, pursuant to a delegation described in subsection 
                (d)(4)(B), to a State or a Gateway (as defined in 
                section 3101 of the Public Health Service Act) return 
                information of a taxpayer who may be eligible for 
                credits under section 3111 of the Public Health Service 
                Act.
                    ``(B) Provision of information.--If a taxpayer 
                authorizes the disclosure described in subparagraph 
                (A), the Secretary shall disclose to the Secretary of 
                Health and Human Services (or, pursuant to a delegation 
                described in subsection (d)(4)(B), to a State or a 
                Gateway) the minimum necessary amount of information 
                necessary to establish whether such individual is 
                eligible for credits under section 3111 of the Public 
                Health Service Act.
                    ``(C) Restriction on use of disclosed 
                information.--Return information disclosed under 
                subparagraph (A) may be used by the Secretary (or, 
                pursuant to a delegation described in subsection 
                (d)(4)(B), a State or a Gateway) only for the purposes 
                of, and to the extent necessary in, establishing the 
                appropriate amount of any payments under section 3111 
                of the Public Health Service Act.''.
    (b) Collection of Amounts.--Section 6305(a) of the Internal Revenue 
Code of 1986 is amended by inserting ``or under section 3111 of the 
Public Health Service Act'' after ``Social Security Act''.
    (c) Conforming Amendments.--
            (1) Paragraph (3) of section 6103(a) of such Code is 
        amended by striking ``or (20)'' and inserting ``(20), or 
        (21)''.
            (2) Paragraph (4) of section 6103(p) of such Code is 
        amended by striking ``(l)(10), (16), (18), (19), or (20)'' each 
        place it appears and inserting ``(l)(10), (16), (18), (19), 
        (20), or (21)''.
            (3) Paragraph (2) of section 7213(a) of such Code is 
        amended by striking ``or (20)'' and inserting ``(20), or 
        (21)''.

           Subtitle D--Shared Responsibility for Health Care

SEC. 161. INDIVIDUAL RESPONSIBILITY.

    (a) Payments.--
            (1) In general.--Subchapter A of chapter 1 of the Internal 
        Revenue Code of 1986 (relating to determination of tax 
        liability) is amended by adding at the end the following new 
        part:

              ``PART VIII--SHARED RESPONSIBILITY PAYMENTS

``Sec. 59B. Shared responsibility payments.

``SEC. 59B. SHARED RESPONSIBILITY PAYMENTS.

    ``(a) Requirement.--Every individual shall ensure that such 
individual, and each dependent of such individual, is covered under 
qualifying coverage at all times during the taxable year.
    ``(b) Payment.--
            ``(1) In general.--
                    ``(A) In general.--In the case of any individual 
                who did not have in effect qualifying coverage (as 
                defined in section 3116 of the Public Health Service 
                Act) for any month during the taxable year, there is 
                hereby imposed for the taxable year, in addition to any 
                other amount imposed by this subtitle, an amount equal 
                to the amount established under paragraph (2).
                    ``(B) Rule for dependents.--Any amount to be 
                imposed under this subsection with respect to an 
                individual described in subparagraph (A) that is a 
                dependent (as defined in section 152) of another 
                taxpayer shall be imposed--
                            ``(i) except in any case described in 
                        clause (ii), upon the taxpayer on whom such 
                        individual is a dependent; or
                            ``(ii) in any case in which the taxpayer 
                        with respect to whom such individual is a 
                        dependent files a joint return, jointly upon 
                        the taxpayer and the spouse of the taxpayer.
                    ``(C) Limitation.--The maximum amount imposed under 
                this paragraph with respect to any taxpayer shall not 
                exceed 4 times the amount determined under paragraph 
                (2)(D).
            ``(2) Amount established.--
                    ``(A) Requirement to establish.--Not later than 
                June 30 of each calendar year, the Secretary, in 
                consultation with the Secretary of Health and Human 
                Services and with the States, shall establish an amount 
                for purposes of paragraph (1).
                    ``(B) Effective date.--The amount established under 
                subparagraph (A) shall be effective with respect to the 
                taxable year following the date on which the amount 
                under subparagraph (A) is established.
                    ``(C) Required consideration.--Subject to the 
                limitation described in subparagraph (D), in 
                establishing the amount under subparagraph (A), the 
                Secretary shall seek to establish the minimum 
                practicable amount that can accomplish the goal of 
                enhancing participation in qualifying coverage (as so 
                defined).
                    ``(D) Limitation.--
                            ``(i) In general.--Subject to an adjustment 
                        under clause (ii), the amount established under 
                        this subparagraph is $750.
                            ``(ii) Inflation adjustment.--Beginning 
                        with taxable years after 2011, the amount 
                        described in clause (i) shall be adjusted by 
                        the Secretary by notice, published in the 
                        Federal Register, for each fiscal year to 
                        reflect the total percentage change that 
                        occurred in the medical care component of the 
                        Consumer Price Index for all urban consumers 
                        (all items; U.S. city average) during the 
                        preceding calendar year.
    ``(c) Exemptions.--Subsection (b) shall not apply to any 
individual--
            ``(1) with respect to any month if such month occurs during 
        any period in which such individual did not have qualifying 
        coverage (as so defined) for a period of less than 90 days,
            ``(2) who is a resident of a State that is not a 
        participating State or an establishing State (as such terms are 
        defined in section 3104 of the Public Health Service Act),
            ``(3) who is an Indian as defined in section 4 of the 
        Indian Health Care Improvement Act,
            ``(4) for whom affordable health care coverage is not 
        available (as such terms are defined by the Secretary of Health 
        and Human Services under section 3103 of the Public Health 
        Service Act), or
            ``(5) described in section 3116(a)(4)(C) of the Public 
        Health Service Act.
    ``(d) Coordination With Other Provisions.--
            ``(1) Not treated as tax for certain purposes.--The amount 
        imposed by this section shall not be treated as a tax imposed 
        by this chapter for purposes of determining--
                    ``(A) the amount of any credit allowable under this 
                chapter, or
                    ``(B) the amount of the minimum tax imposed by 
                section 55.
            ``(2) Treatment under subtitle f.--For purposes of subtitle 
        F, the amount imposed by this section shall be treated as if it 
        were a tax imposed by section 1.
            ``(3) Section 15 not to apply.--Section 15 shall not apply 
        to the amount imposed by this section.
            ``(4) Section not to affect liability of possessions, 
        etc.--This section shall not apply for purposes of determining 
        liability to any possession of the United States. For purposes 
        of section 932 and 7654, the amount imposed under this section 
        shall not be treated as a tax imposed by this chapter.
    ``(e) Uses.--Amounts collected under this section shall be 
dedicated to premium credits established under section 3111 of the 
Public Health Service Act.
    ``(f) Regulations.--The Secretary may prescribe such regulations as 
may be appropriate to carry out the purposes of this section.''.
            (2) Clerical amendment.--The table of parts for subchapter 
        A of chapter 1 of such Code is amended by adding at the end the 
        following new item:

             ``PART VIII--Shared Responsibility Payments''.

            (3) Effective date.--The amendments made by this section 
        shall apply to taxable years beginning after December 31, 2011.
    (b) Reporting of Health Insurance Coverage.--
            (1) In general.--Part III of subchapter A of chapter 61 of 
        the Internal Revenue Code of 1986 is amended by inserting after 
        subpart B the following new subpart:

      ``Subpart D--Information Regarding Health Insurance Coverage

``Sec. 6055. Reporting of health insurance coverage.

``SEC. 6055. REPORTING OF HEALTH INSURANCE COVERAGE.

    ``(a) In General.--Every person who provides health insurance that 
is qualifying coverage shall make a return described in subsection (b).
    ``(b) Form and Manner of Return.--A return is described in this 
subsection if such return--
            ``(1) is in such form as the Secretary prescribes,
            ``(2) contains--
                    ``(A) the name, address, and taxpayer 
                identification number of each individual who is covered 
                under health insurance that is qualifying coverage 
                provided by such person, and
                    ``(B) the number of months during the calendar year 
                during which each such individual was covered under 
                such health insurance, and
            ``(3) such other information as the Secretary may 
        prescribe.
    ``(c) Statements to Be Furnished to Individuals With Respect to 
Whom Information Is Reported.--
            ``(1) In general.--Every person required to make a return 
        under subsection (a) shall furnish to each individual whose 
        name is required to be set forth in such return a written 
        statement showing--
                    ``(A) the name, address, and phone number of the 
                information contact of the person required to make such 
                return, and
                    ``(B) the number of months during the calendar year 
                during which such individual was covered under health 
                insurance that is qualifying coverage provided by such 
                person.
            ``(2) Time for furnishing statements.--The written 
        statement required under paragraph (1) shall be furnished on or 
        before January 31 of the year following the calendar year for 
        which the return under subsection (a) was required to be made.
    ``(d) Qualifying Coverage.--For purposes of this section, the term 
`qualifying coverage' has the meaning given such term under section 
3116 of the Public Health Service Act.''.
            (2) Conforming amendments.--The table of subparts for part 
        III of subchapter A of chapter 61 of such Code is amended by 
        inserting after the item relating to subpart C the following 
        new item:

               ``subpart d--health insurance coverage''.

            (3) Effective date.--The amendments made by this section 
        shall apply to taxable years beginning after December 31, 2011.
    (c) Notification of Nonenrollment.--Not later than June 30 of each 
year, the Secretary of the Treasury, acting through the Internal 
Revenue Service and in consultation with the Secretary of Health and 
Human Services, shall send a notification each individual who files an 
individual income tax return and who is not enrolled in qualifying 
coverage (as defined in section 3116 of the Public Health Service Act). 
Such notification shall contain information on the services available 
through the Gateway (if any) operating in the State in which such 
individual resides.

SEC. 162. NOTIFICATION ON THE AVAILABILITY OF AFFORDABLE HEALTH 
              CHOICES.

    The Fair Labor Standards Act of 1938 is amended by inserting after 
section 18 (29 U.S.C. 218) the following:

``SEC. 18A. NOTICE TO EMPLOYEES.

    ``(a) In General.--In accordance with regulations promulgated by 
the Secretary, an employer to which this Act applies, shall provide to 
each employee at the time of hiring (or with respect to current 
employees, within 90 days of the date on which a State becomes an 
establishing or participating State under section 3104 of the Public 
Health Service Act), written notice informing the employee of the 
existence of the American Health Benefits Gateway, including a 
description of the services provided by such Gateway and the manner in 
which the employee may contact the Gateway to request assistance.
    ``(b) Effective Date.--Subsection (a) shall take effect with 
respect to employers in a State beginning 90 days after the date on 
which the State becomes an establishing or participating State under 
section 3104 of the Public Health Service. Act.''.

SEC. 163. SHARED RESPONSIBILITY OF EMPLOYERS.

    Subtitle B of title XXXI of the Public Health Service Act, as 
amended by section 151, is further amended by adding at the end the 
following:

``SEC. 3115. SHARED RESPONSIBILITY OF EMPLOYERS.

    ``(a) Employees Not Offered Coverage.--An employer shall make a 
payment to the Secretary in the amount described in subsection (b) with 
respect to each employee--
            ``(1) who is not offered qualifying coverage by such 
        employer during each month where such employee is not offered 
        qualifying coverage; or
            ``(2) on behalf of whom such employer is not contributing 
        at least 60 percent of the monthly premiums for such coverage 
        for each such month.
    ``(b) Amount.--
            ``(1) In general.--The annual amount described in this 
        subsection shall be equal to $750 for each full-time employee 
        described in subsection (a). Such amount shall be pro-rated 
        with respect to each month in which subsection (a) applies with 
        respect to an employee.
            ``(2) Pro rata application for part-time employees.--The 
        provisions of paragraph (1) shall apply with respect to part-
        time employees employed by the employer, except that the annual 
        payment amount described in such paragraph shall be reduced to 
        $375 for each part-time employee.
            ``(3) Application.--The provisions of this subsection shall 
        only apply with respect to the number of employees employed by 
        the employer in excess of 25 employees.
    ``(c) Procedures.--The Secretary shall develop procedures for 
making determinations with respect to qualifying coverage and for 
making the payments required under subsection (a). Such procedures 
shall provide for the making of payments on a quarterly basis.
    ``(d) Use of Funds.--Amounts shall be collected under subsection 
(a) and be available for obligation only to the extent and in the 
amount provided in advance in appropriations Acts. Such amounts are 
authorized to remain available until expended.
    ``(e) Inflation Adjustment.--Beginning with calendar years after 
2013, the amounts described in subsection (b) shall be adjusted by the 
Secretary by notice, published in the Federal Register, for each fiscal 
year to reflect the total percentage change that occurred in the 
medical care component of the Consumer Price Index for all urban 
consumers (all items; U.S. city average) during the preceding calendar 
year.
    ``(f) Exemption for Small Employers.--
            ``(1) In general.--For purposes of this section, the term 
        `employer' means an employer that employs more than 25 
        employees on business days during the preceding calendar year. 
        An employer shall not be considered to employ more than 25 
        employees if--
                    ``(A) the employer's workforce exceeds 25 employees 
                for 120 days or fewer during the calendar year; and
                    ``(B) the employees employed during such 120-day 
                period were seasonal workers.
            ``(2) Definition of seasonal workers.--In this subsection, 
        the term `seasonal worker' means an individual who performs 
        labor or services on a seasonal basis where, ordinarily, the 
        employment pertains to or is of the kind exclusively performed 
        at certain seasons or periods of the year and which, from its 
        nature, may not be continuous or carried on throughout the 
        year.
            ``(3) Application of aggregation rule for employers.--All 
        persons treated as a single employer under subsection (b), (c), 
        (m), or (o) of section 414 of the Internal Revenue Code of 1986 
        shall be treated as 1 employer.
            ``(4) Employers not in existence in preceding year.--In the 
        case of an employer which was not in existence throughout the 
        preceding calendar year, the determination of whether such 
        employer is a small or large employer shall be based on the 
        average number of employees that it is reasonably expected such 
        employer will employ on business days in the current calendar 
        year.
            ``(5) Predecessors.--Any reference in this subsection to an 
        employer shall include a reference to any predecessor of such 
        employer.
    ``(g) Authority to Certify.--The Secretary, in collaboration with 
the Secretary of the Treasury and the Secretary of Labor, shall 
establish procedures for determining the number of employees of 
employers who are not offered qualifying coverage.
    ``(h) Independent Contractors.--For purposes of determining whether 
an employer is subject to this section, any individual who qualifies as 
an independent contractor under Federal law and who is retained by such 
employer shall not be counted when determining the number of employees 
employed by the employer.
    ``(i) Regulations.--The Secretary, in consultation with the 
Secretary of Labor, shall promulgate such regulations as may be 
appropriate to carry out activities under this section.
    ``(j) Effective Date.--This section shall apply with respect to an 
employer beginning in the calendar year in which the State in which the 
employer is located becomes an establishing State or a participating 
State.

``SEC. 3116. DEFINITIONS.

    ``(a) In General.--In this title:
            ``(1) Eligible individual.--The term `eligible individual' 
        means an individual who is--
                    ``(A) a citizen or national of the United States or 
                an alien lawfully admitted to the United States for 
                permanent residence or an alien lawfully present in the 
                United States;
                    ``(B) a qualified individual;
                    ``(C) enrolled in a qualified health plan; and
                    ``(D) not receiving full benefits coverage under a 
                State child health plan under title XXI of the Social 
                Security Act (42 U.S.C. 1397aa et seq.) (or full 
                benefits coverage under a demonstration project funded 
                through such title XXI).
            ``(2) Qualified employer.--
                    ``(A) In general.--The term `qualified employer' 
                means an employer that--
                            ``(i) elects to make all full-time 
                        employees of such employer eligible for a 
                        qualified health plan; and
                            ``(ii)(I) in the case of an employer that 
                        elects to make its employees eligible for 
                        qualified health plans in an establishing 
                        State--
                                    ``(aa) employs fewer than the 
                                number of employees specified in 
                                subparagraph (B); and
                                    ``(bb) meets criteria established 
                                by the State; or
                            ``(II) in the case of an employer that 
                        elects to make its employees eligible for 
                        qualified health plans in a participating 
                        State--
                                    ``(aa) employs fewer than the 
                                number of employees specified in 
                                subparagraph (B); and
                                    ``(bb) meets criteria established 
                                by the Secretary.
                    ``(B) Number of employees.--
                            ``(i) Establishment.--
                                    ``(I) By state.--In the case of an 
                                establishing State, such State may by 
                                regulation establish the number of 
                                employees described in subparagraph 
                                (A)(ii)(I)(aa) but such number may not 
                                be less than 50.
                                    ``(II) By the secretary.--In the 
                                case of a participating State, the 
                                Secretary may by regulation establish 
                                the number of employees described in 
                                subparagraph (A)(ii)(II)(aa) but such 
                                number may not be less than 50.
                            ``(ii) Default.--If a State or the 
                        Secretary does not establish the number 
                        described in subclause (I) or (II), 
                        respectively, of clause (i), such number shall 
                        be 50.
                    ``(C) Continuation of participation.--A qualified 
                employer that is enrolled in a qualified health plan 
                and that experiences an increase in the number of 
                employees of such employer such that the number of 
                employees of such employer exceeds the number specified 
                in subparagraph (B)(i) or subparagraph (B)(ii), as 
                applicable, shall, notwithstanding such increase, 
                continue to be considered a qualified employer for 
                purposes of this title, provided that such employer 
                remains enrolled in a qualified health plan.
            ``(3) Qualified health plan.--
                    ``(A) In general.--The term `qualified health plan' 
                means health plan that--
                            ``(i) has in effect a certification (which 
                        may include a seal or other indication of 
                        approval) that such plan meets the criteria for 
                        certification described in section 3101(m) 
                        issued or recognized by each Gateway through 
                        which such plan is offered; and
                            ``(ii) is offered by a health insurance 
                        issuer that--
                                    ``(I) is licensed and in good 
                                standing to offer health insurance 
                                coverage in each State in which such 
                                issuer offers health insurance coverage 
                                under this title;
                                    ``(II) agrees to offer at least one 
                                qualified health plan in the tier 
                                described in section 3111(a)(1)(A) and 
                                at least one plan in the tier described 
                                in section 3111(a)(1)(B);
                                    ``(III) complies with the 
                                regulations developed by the Secretary 
                                under section 3101(m) and such other 
                                requirements as an applicable Gateway 
                                may establish; and
                                    ``(IV) agrees to pay any surcharge 
                                assessed under section 3101(c)(4).
                    ``(B) Inclusion of community health insurance 
                option.--Any reference in this title to a qualified 
                health plan shall be deemed to include a community 
                health insurance option, unless specifically provided 
                for otherwise.
            ``(4) Qualified individual.--
                    ``(A) In general.--The term `qualified individual' 
                means an individual who is--
                            ``(i) residing in a participating State or 
                        an establishing State (as defined in section 
                        3104);
                            ``(ii) not incarcerated, except an 
                        individual in custody pending the disposition 
                        of charges;
                            ``(iii) not entitled to coverage under the 
                        Medicare program under part A of title XVIII of 
                        the Social Security Act;
                            ``(iv) not enrolled in coverage under the 
                        Medicare program under part B of title XVIII of 
                        the Social Security Act or under part C of such 
                        title; and
                            ``(v) not eligible for coverage under--
                                    ``(I) the Medicaid program under a 
                                State plan under title XIX of the 
                                Social Security Act (42 U.S.C. 1396 et 
                                seq.), or under a waiver under section 
                                1115 of such Act;
                                    ``(II) the TRICARE program under 
                                chapter 55 of title 10, United States 
                                Code (as defined in section 1072(7) of 
                                such title);
                                    ``(III) the Federal employees 
                                health benefits program under chapter 
                                89 of title 5, United States Code; or
                                    ``(IV) employer-sponsored coverage 
                                (except as provided under subparagraph 
                                (B)).
                    ``(B) Employees without affordable coverage.--An 
                individual who is eligible for employer-sponsored 
                coverage shall be deemed to be a qualified individual 
                under subparagraph (A) only if such coverage--
                            ``(i) does not meet the criteria 
                        established under section 3103 for minimum 
                        qualifying coverage; or
                            ``(ii) is not affordable (as such term is 
                        defined by the Secretary under section 3103) 
                        for such employee.
                    ``(C) Individuals at less than 150 percent of 
                poverty.--An individual with an adjusted gross income 
                that does not exceed 150 percent of the poverty line 
                for a family of the size involved shall not be 
                considered a qualified individual for purposes of this 
                title.
            ``(5) Qualifying coverage.--The term `qualifying coverage' 
        means--
                    ``(A) a group health plan or health insurance 
                coverage--
                            ``(i) that an individual is enrolled in on 
                        the date of enactment of this title; or
                            ``(ii) that is described in clause (i) and 
                        that is renewed by an enrollee as provided for 
                        in section 131 of the Affordable Health Choices 
                        Act;
                    ``(B) a group health plan or health insurance 
                coverage that--
                            ``(i) is not described in subparagraph (A); 
                        and
                            ``(ii) meets or exceeds the criteria for 
                        minimum qualifying coverage (as defined in 
                        section 3103);
                    ``(C) Medicare coverage under parts A and B of 
                title XVIII of the Social Security Act or under part C 
                of such title;
                    ``(D) Medicaid coverage under a State plan under 
                title XIX of the Social Security Act (or under a waiver 
                under section 1115 of such Act), other than coverage 
                consisting solely of benefits under section 1928 of 
                such Act;
                    ``(E) coverage under title XXI of the Social 
                Security Act;
                    ``(F) coverage under the TRICARE program under 
                chapter 55 of title 10, United States Code;
                    ``(G) coverage under the veteran's health care 
                program under chapter 17 of title 38, United States 
                Code, but only if the coverage for the individual 
                involved is determined by the Secretary to be not less 
                than the coverage provided under a qualified health 
                plan, based on the individual's priority for services 
                as provided under section 1705(a) of such title;
                    ``(H) coverage under the Federal employees health 
                benefits program under chapter 89 of title 5, United 
                States Code;
                    ``(I) a State health benefits high risk pool;
                    ``(J) a health benefit plan under section 2504(e) 
                of title 22, United States Code; or
                    ``(K) coverage under a qualified health plan.
        For purposes of this paragraph, an individual shall be deemed 
        to have qualifying coverage if such individual is an individual 
        described in section 1402(e) or (g) of the Internal Revenue 
        Code of 1986.
            ``(6) Adjusted gross income.--The term `adjusted gross 
        income' with respect to an individual has the meaning given 
        such term for purposes of section 62(a) of the Internal Revenue 
        Code of 1986.
            ``(7) Educated health care consumer.--The term `educated 
        health care consumer' means an individual who is knowledgeable 
        about the health care system, and has background or experience 
        in making informed decisions regarding health, medical, and 
        scientific matters.
    ``(b) Incorporation of Additional Definitions.--Unless specifically 
provided for otherwise, the definitions contained in section 2791 shall 
apply with respect to this title.''.

          Subtitle E--Improving Access to Health Care Services

SEC. 171. SPENDING FOR FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS).

    (a) In General.--Section 330(r) of the Public Health Service Act 
(42 U.S.C. 254b(r)) is amended by striking paragraph (1) and inserting 
the following:
            ``(1) General amounts for grants.--For the purpose of 
        carrying out this section, in addition to the amounts 
        authorized to be appropriated under subsection (d), there is 
        authorized to be appropriated the following:
                    ``(A) For fiscal year 2010, $2,988,821,592.
                    ``(B) For fiscal year 2011, $3,862,107,440.
                    ``(C) For fiscal year 2012, $4,990,553,440.
                    ``(D) For fiscal year 2013, $6,448,713,307.
                    ``(E) For fiscal year 2014, $7,332,924,155.
                    ``(F) For fiscal year 2015, $8,332,924,155.
                    ``(G) For fiscal year 2016, and each subsequent 
                fiscal year, the amount appropriated for the preceding 
                fiscal year adjusted by the product of--
                            ``(i) one plus the average percentage 
                        increase in costs incurred per patient served; 
                        and
                            ``(ii) one plus the average percentage 
                        increase in the total number of patients 
                        served.''.
    (b) Rule of Construction.--Section 330(r) of the Public Health 
Service Act (42 U.S.C. 254b(r)) is amended by adding at the end the 
following:
            ``(4) Rule of construction with respect to rural health 
        clinics.--
                    ``(A) In general.--Nothing in this section shall be 
                construed to prevent a community health center from 
                contracting with a Federally certified rural health 
                clinic (as defined in section 1861(aa)(2) of the Social 
                Security Act), a low-volume hospital (as defined for 
                purposes of section 1886 of such Act), a critical 
                access hospital, a sole community hospital (as defined 
                for purposes of section 1886(d)(5)(D)(iii) of such 
                Act), or a medicare-dependent share hospital (as 
                defined for purposes of section 1886(d)(5)(G)(iv) of 
                such Act) for the delivery of primary health care 
                services that are available at the clinic or hospital 
                to individuals who would otherwise be eligible for free 
                or reduced cost care if that individual were able to 
                obtain that care at the community health center. Such 
                services may be limited in scope to those primary 
                health care services available in that clinic or 
                hospitals.
                    ``(B) Assurances.--In order for a clinic or 
                hospital to receive funds under this section through a 
                contract with a community health center under 
                subparagraph (A), such clinic or hospital shall 
                establish policies to ensure--
                            ``(i) nondiscrimination based on the 
                        ability of a patient to pay; and
                            ``(ii) the establishment of a sliding fee 
                        scale for low-income patients.''.

SEC. 172. OTHER PROVISIONS.

    (a) Settings for Service Delivery.--Section 330(a)(1) of the Public 
Health Service Act (42 U.S.C. 254b(a)(1)) is amended by adding at the 
end the following: ``Required primary health services and additional 
health services may be provided either at facilities directly operated 
by the center or at any other inpatient or outpatient settings 
determined appropriate by the center to meet the needs of its 
patents.''.
    (b) Location of Service Delivery Sites.--Section 330(a) of the 
Public Health Service Act (42 U.S.C. 254b(a)) is amended by adding at 
the end the following:
            ``(3) Considerations.--
                    ``(A) Location of sites.--Subject to subparagraph 
                (B), a center shall not be required to locate its 
                service facility or facilities within a designated 
                medically underserved area in order to serve either the 
                residents of its catchment area or a special medically 
                underserved population comprised of migratory and 
                seasonal agricultural workers, the homeless, or 
                residents of public housing, if that location is 
                determined by the center to be reasonably accessible to 
                and appropriate to meet the needs of the medically 
                underserved residents of the center's catchment area or 
                the special medically underserved population, in 
                accordance with subparagraphs (A) and (J) of subsection 
                (k)(3).
                    ``(B) Location within another center's area.--The 
                Secretary may permit applicants for grants under this 
                section to propose the location of a service delivery 
                site within another center's catchment area if the 
                applicant demonstrates sufficient unmet need in such 
                area and can otherwise justify the need for additional 
                Federal resources in the catchment area. In determining 
                whether to approve such a proposal, the Secretary shall 
                take into consideration whether collaboration between 
                the two centers exists, or whether the applicant has 
                made reasonable attempts to establish such 
                collaboration, and shall consider any comments timely 
                submitted by the affected center concerning the 
                potential impact of the proposal on the availability or 
                accessibility of services the affected center currently 
                provides or the financial viability of the affected 
                center.''.
    (c) Affiliation Agreements.--Section 330(k)(3)(B) of the Public 
Health Service Act (42 U.S.C. 254b(k)(3)(B)) is amended by inserting 
before the semicolon the following: ``, including contractual 
arrangements as appropriate, while maintaining full compliance with the 
requirements of this section, including the requirements of 
subparagraph (H) concerning the composition and authorities of the 
center's governing board, and, except as otherwise provided in clause 
(ii) of such subparagraph, ensuring full autonomy of the center over 
policies, direction, and operations related to health care delivery, 
personnel, finances, and quality assurance''.
    (d) Governance Requirements.--Section 330(k)(3) of the Public 
Health Service Act (42 U.S.C. 254b(k)(3)) is amended--
            (1) in subparagraph (H)--
                    (A) in clause (ii), strike ``; and'' and inserting 
                ``, except that in the case of a public center (as 
                defined in the second sentence of this paragraph), the 
                public entity may retain authority to establish 
                financial and personnel policies for the center; and'';
                    (B) in clause (iii), by adding ``and'' at the end; 
                and
                    (C) by inserting after clause (iii) the following:
                            ``(iv) in the case of a co-applicant with a 
                        public entity, meets the requirements of 
                        clauses (i) and (ii);''; and
            (2) in the second sentence, by inserting before the period 
        the following: ``that is governed by a board that satisfies the 
        requirements of subparagraph (H) or that jointly applies (or 
        has applied) for funding with a co-applicant board that meets 
        such requirements''.
    (e) Adjustment in Center's Operating Plan and Budget.--Section 
330(k)(3)(I)(i) of the Public Health Service Act (42 U.S.C. 
254b(k)(3)(I)(i)) is amended by adding before the semicolon the 
following: ``, which may be modified by the center at any time during 
the fiscal year involved if such modifications do not require 
additional grant funds, do not compromise the availability or 
accessibility of services currently provided by the center, and 
otherwise meet the conditions of subsection (a)(3)(B), except that any 
such modifications that do not comply with this clause, as determined 
by the health center, shall be submitted to the Secretary for 
approval''.
    (f) Joint Purchasing Arrangements for Reduced Cost.--Section 330(l) 
of the Public Health Service Act (42 U.S.C. 254b(l)) is amended--
            (1) by striking ``The Secretary'' and inserting the 
        following:
            ``(1) In general.--The Secretary''; and
            (2) by adding at the end the following:
            ``(2) Assistance with supplies and services costs.--The 
        Secretary, directly or through grants or contracts, may carry 
        out projects to establish and administer arrangements under 
        which the costs of providing the supplies and services needed 
        for the operation of federally qualified health centers are 
        reduced through collaborative efforts of the centers, through 
        making purchases that apply to multiple centers, or through 
        such other methods as the Secretary determines to be 
        appropriate.''.
    (g) Opportunity To Correct Material Failure Regarding Grant 
Conditions.--Section 330(e) of the Public Health Service Act (42 U.S.C. 
254b(e)) is amended by adding at the end the following:
            ``(6) Opportunity to correct material failure regarding 
        grant conditions.--If the Secretary finds that a center 
        materially fails to meet any requirement (except for any 
        requirements waived by the Secretary) necessary to qualify for 
        its grant under this subsection, the Secretary shall provide 
        the center with an opportunity to achieve compliance (over a 
        period of up to 1 year from making such finding) before 
        terminating the center's grant. A center may appeal and obtain 
        an impartial review of any Secretarial determination made with 
        respect to a grant under this subsection, or may appeal and 
        receive a fair hearing on any Secretarial determination 
        involving termination of the center's grant entitlement, 
        modification of the center's service area, termination of a 
        medically underserved population designation within the 
        center's service area, disallowance of any grant expenditures, 
        or a significant reduction in a center's grant amount.''.

SEC. 173. NEGOTIATED RULEMAKING FOR DEVELOPMENT OF METHODOLOGY AND 
              CRITERIA FOR DESIGNATING MEDICALLY UNDERSERVED 
              POPULATIONS AND HEALTH PROFESSIONS SHORTAGE AREAS.

    (a) Establishment.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall 
        establish, through a negotiated rulemaking process under 
        subchapter 3 of chapter 5 of title 5, United States Code, a 
        comprehensive methodology and criteria for designation of--
                    (A) medically underserved populations in accordance 
                with section 330(b)(3) of the Public Health Service Act 
                (42 U.S.C. 254b(b)(3));
                    (B) health professions shortage areas under section 
                332 of the Public Health Service Act (42 U.S.C. 254e).
            (2) Factors to consider.--In establishing the methodology 
        and criteria under paragraph (1), the Secretary--
                    (A) shall consult with relevant stakeholders who 
                will be significantly affected by a rule (such as 
                national, State and regional organizations representing 
                affected entities), State health offices, community 
                organizations, health centers and other affected 
                entities, and other interested parties; and
                    (B) shall take into account--
                            (i) the timely availability and 
                        appropriateness of data used to determine a 
                        designation to potential applicants for such 
                        designations;
                            (ii) the impact of the methodology and 
                        criteria on communities of various types and on 
                        health centers and other safety net providers;
                            (iii) the degree of ease or difficulty that 
                        will face potential applicants for such 
                        designations in securing the necessary data; 
                        and
                            (iv) the extent to which the methodology 
                        accurately measures various barriers that 
                        confront individuals and population groups in 
                        seeking health care services.
    (b) Publication of Notice.--In carrying out the rulemaking process 
under this subsection, the Secretary shall publish the notice provided 
for under section 564(a) of title 5, United States Code, by not later 
than 45 days after the date of the enactment of this Act.
    (c) Target Date for Publication of Rule.--As part of the notice 
under subsection (b), and for purposes of this subsection, the ``target 
date for publication'', as referred to in section 564(a)(5) of title 5, 
United Sates Code, shall be July 1, 2010.
    (d) Appointment of Negotiated Rulemaking Committee and 
Facilitator.--The Secretary shall provide for--
            (1) the appointment of a negotiated rulemaking committee 
        under section 565(a) of title 5, United States Code, by not 
        later than 30 days after the end of the comment period provided 
        for under section 564(c) of such title; and
            (2) the nomination of a facilitator under section 566(c) of 
        such title 5 by not later than 10 days after the date of 
        appointment of the committee.
    (e) Preliminary Committee Report.--The negotiated rulemaking 
committee appointed under subsection (d) shall report to the Secretary, 
by not later than April 1, 2010, regarding the committee's progress on 
achieving a consensus with regard to the rulemaking proceeding and 
whether such consensus is likely to occur before one month before the 
target date for publication of the rule. If the committee reports that 
the committee has failed to make significant progress toward such 
consensus or is unlikely to reach such consensus by the target date, 
the Secretary may terminate such process and provide for the 
publication of a rule under this section through such other methods as 
the Secretary may provide.
    (f) Final Committee Report.--If the committee is not terminated 
under subsection (e), the rulemaking committee shall submit a report 
containing a proposed rule by not later than one month before the 
target publication date.
    (g) Interim Final Effect.--The Secretary shall publish a rule under 
this section in the Federal Register by not later than the target 
publication date. Such rule shall be effective and final immediately on 
an interim basis, but is subject to change and revision after public 
notice and opportunity for a period (of not less than 90 days) for 
public comment. In connection with such rule, the Secretary shall 
specify the process for the timely review and approval of applications 
for such designations pursuant to such rules and consistent with this 
section.
    (h) Publication of Rule After Public Comment.--The Secretary shall 
provide for consideration of such comments and republication of such 
rule by not later than 1 year after the target publication date.

SEC. 174. EQUITY FOR CERTAIN ELIGIBLE SURVIVORS.

    (a) Rebuttable Presumption.--Section 411(c)(4) of the Black Lung 
Benefits Act (30 U.S.C. 921(c)(4)) is amended by striking the last 
sentence.
    (b) Continuation of Benefits.--Section 422(l) of the Black Lung 
Benefits Act (30 U.S.C. 932(l)) is amended by striking ``, except with 
respect to a claim filed under this part on or after the effective date 
of the Black Lung Benefits Amendments of 1981''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to claims filed under part B or part C of the Black 
Lung Benefits Act (30 U.S.C. 921 et seq., 931 et seq.) after January 1, 
2005, that are pending on or after the date of enactment of this Act.

SEC. 175. REAUTHORIZATION OF THE WAKEFIELD EMERGENCY MEDICAL SERVICES 
              FOR CHILDREN PROGRAM.

    Section 1910 of the Public Health Service Act (42 U.S.C. 300w-9) is 
amended--
            (1) in subsection (a), by striking ``3-year period (with an 
        optional 4th year'' and inserting ``4-year period (with an 
        optional 5th year''; and
            (2) in subsection (d)--
                    (A) by striking ``and such sums'' and inserting 
                ``such sums''; and
                    (B) by inserting before the period the following: 
                ``, $25,000,000 for fiscal year 2010, $26,250,000 for 
                fiscal year 2011, $27,562,500 for fiscal year 2012, 
                $28,940,625 for fiscal year 2013, and $30,387,656 for 
                fiscal year 2014''.

SEC. 176. CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-BASED 
              MENTAL HEALTH SETTINGS.

    Subpart 3 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb-31 et seq.) is amended by adding at the end the following:

``SEC. 520K. GRANTS FOR CO-LOCATING PRIMARY AND SPECIALTY CARE IN 
              COMMUNITY-BASED MENTAL HEALTH SETTINGS.

    ``(a) Definitions.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means a 
        qualified community mental health program defined under section 
        1913(b)(1).
            ``(2) Special populations.--The term `special populations' 
        refers to the following 3 groups:
                    ``(A) Children and adolescents with mental and 
                emotional disturbances who have co-occurring primary 
                care conditions and chronic diseases.
                    ``(B) Adults with mental illnesses who have co-
                occurring primary care conditions and chronic diseases.
                    ``(C) Older adults with mental illnesses who have 
                co-occurring primary care conditions and chronic 
                diseases.
    ``(b) Program Authorized.--The Secretary, acting through the 
Administrator of the Substance Abuse and Mental Health Services 
Administration and in coordination with the Director of the Health 
Resources and Services Administration, shall award grants to eligible 
entities to establish demonstration projects for the provision of 
coordinated and integrated services to special populations through the 
co-location of primary and specialty care services in community-based 
mental and behavioral health settings.
    ``(c) Application.--To be eligible to receive a grant under this 
section, an eligible entity shall submit an application to the 
Administrator at such time, in such manner, and accompanied by such 
information as the Administrator may require. Each such application 
shall include--
            ``(1) an assessment of the primary care needs of the 
        patients served by the eligible entity and a description of how 
        the eligible entity will address such needs; and
            ``(2) a description of partnerships, cooperative 
        agreements, or other arrangements with local primary care 
        providers, including community health centers, to provide 
        services to special populations.
    ``(d) Use of Funds.--
            ``(1) In general.--For the benefit of special populations, 
        an eligible entity shall use funds awarded under this section 
        for--
                    ``(A) the provision, by qualified primary care 
                professionals on a reasonable cost basis, of--
                            ``(i) primary care services on site at the 
                        eligible entity;
                            ``(ii) diagnostic and laboratory services; 
                        or
                            ``(iii) adult and pediatric eye, ear, and 
                        dental screenings;
                    ``(B) reasonable costs associated with medically 
                necessary referrals to qualified specialty care 
                professionals as well as to other coordinators of care 
                or, if permitted by the terms of the grant, for the 
                provision, by qualified specialty care professionals on 
                a reasonable cost basis on site at the eligible entity;
                    ``(C) information technology required to 
                accommodate the clinical needs of primary and specialty 
                care professionals; or
                    ``(D) facility improvements or modifications needed 
                to bring primary and specialty care professionals on 
                site at the eligible entity.
            ``(2) Limitation.--Not to exceed 15 percent of grant funds 
        may be used for activities described in subparagraphs (C) and 
        (D) of paragraph (1).
    ``(e) Geographic Distribution.--The Secretary shall ensure that 
grants awarded under this section are equitably distributed among the 
geographical regions of the United States and between urban and rural 
populations.
    ``(f) Evaluation.--Not later than 3 months after a grant or 
cooperative agreement awarded under this section expires, an eligible 
entity shall submit to the Secretary the results of an evaluation to be 
conducted by the entity concerning the effectiveness of the activities 
carried out under the grant or agreement.
    ``(g) Report.--Not later than 5 years after the date of enactment 
of this section, the Secretary shall prepare and submit to the 
appropriate committees of Congress a report that shall evaluate the 
activities funded under this section. The report shall include an 
evaluation of the impact of co-locating primary and specialty care in 
community mental and behavioral health settings on overall patient 
health status and recommendations on whether or not the demonstration 
program under this section should be made permanent.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $50,000,0000 for fiscal year 
2010 and such sums as may be necessary for each of fiscal years 2011 
through 2014.''.

      Subtitle F--Making Health Care More Affordable for Retirees

SEC. 181. REINSURANCE FOR RETIREES.

    (a) Administration.--
            (1) In general.--Not later than 90 days after the date of 
        enactment of this section, the Secretary shall establish a 
        temporary reinsurance program to provide reimbursement to 
        participating employment-based plans for a portion of the cost 
        of providing health benefits to retirees whose primary 
        residence is located in any State that is not a participating 
        State or an establishing State (as described in section 3104) 
        for a portion of the cost of providing health insurance 
        coverage to retirees (and to the eligible spouses, surviving 
        spouses, and dependents of such retirees) during the period 
        beginning on the date on which such program is established and 
        ending on the date on which such State becomes a participating 
        State or an establishing State.
            (2) Reference.--In this section:
                    (A) Health benefits.--The term ``health benefits'' 
                means medical, surgical, hospital, prescription drug, 
                and such other benefits as shall be determined by the 
                Secretary, whether self-funded, or delivered through 
                the purchase of insurance or otherwise.
                    (B) Employment-based plan.--The term ``employment-
                based plan'' means a group health benefits plan that--
                            (i) is--
                                    (I) maintained by one or more 
                                current or former employers (including 
                                without limitation any State or local 
                                government or political subdivision 
                                thereof), employee organization, a 
                                voluntary employees' beneficiary 
                                association, or a committee or board of 
                                individuals appointed to administer 
                                such plan; or
                                    (II) a multiemployer plan (as 
                                defined in section 3(37) of the 
                                Employee Retirement Income Security Act 
                                of 1974); and
                            (ii) provides health benefits to retirees.
                    (C) Retirees.--The term ``retirees'' means 
                individuals who are age 55 and older but are not 
                eligible for coverage under title XVIII of the Social 
                Security Act, and who are not active employees of an 
                employer maintaining , or currently contributing to, 
                the employment-based plan or of any employer that has 
                made substantial contributions to fund such plan.
    (b) Participation.--
            (1) Employment-based plan eligibility.--To be eligible to 
        participate in the program established under this section, an 
        employment-based plan (as defined in subsection (a)(2) and 
        referred to in this section as a ``participating employment-
        based plan'' shall--
                    (A) provide employment-based health plan benefits; 
                and
                    (B) submit to the Secretary an application for 
                participation in the program, at such time, in such 
                manner, and containing such information as the 
                Secretary shall require.
            (2) Appropriate employment-based health benefits.--
        Appropriate employment-based health benefits described in this 
        paragraph shall--
                    (A) meet the requirements established under section 
                3103(a)(1)(B);
                    (B) implement programs and procedures to generate 
                cost-savings with respect to participants with chronic 
                and high-cost conditions;
                    (C) provide documentation of the actual cost of 
                medical claims involved; and
                    (D) be certified as appropriate by the Secretary.
    (c) Payments.--
            (1) Submission of claims.--
                    (A) In general.--A participating employment-based 
                plan shall submit claims for reimbursement to the 
                Secretary which shall contain documentation of the 
                actual costs of the items and services for which each 
                claim is being submitted.
                    (B) Basis for claims.--Claims submitted under 
                paragraph (1) shall be based on the actual amount 
                expended by the participating employment-based plan 
                involved within the plan year for the appropriate 
                employment-based health benefits provided to a retiree 
                or the spouse, surviving spouse, or dependent of such 
                retiree. In determining the amount of a claim for 
                purposes of this subsection, the participating 
                employment-based plan shall take into account any 
                negotiated price concessions (such as discounts, direct 
                or indirect subsidies, rebates, and direct or indirect 
                remunerations) obtained by such plan with respect to 
                such health benefit. For purposes of determining the 
                amount of any such claim, the costs paid by the retiree 
                or the retiree's spouse, surviving spouse, or dependent 
                in the form of deductibles, co-payments, or co-
                insurance shall be included in the amounts paid by the 
                participating employment-based plan.
            (2) Program payments.--If the Secretary determines that a 
        participating employment-based plan has submitted a valid claim 
        under paragraph (1), the Secretary shall reimburse such plan 
        for 80 percent of that portion of the costs attributable to 
        such claim that exceed $15,000, subject to the limits contained 
        in paragraph (3).
            (3) Limit.--To be eligible for reimbursement under the 
        program, a claim submitted by a participating employment-based 
        plan shall not be less than $15,000 nor greater than $90,000. 
        Such amounts shall be adjusted each fiscal year based on the 
        percentage increase in the Medical Care Component of the 
        Consumer Price Index for all urban consumers (rounded to the 
        nearest multiple of $1,000) for the year involved.
            (4) Use of payments.--Amounts paid to a participating 
        employment-based plan under this subsection shall be used to 
        lower costs for the plan. Such payments may be used to reduce 
        premium costs for an entity described in subsection 
        (a)(2)(B)(i) or to reduce premium contributions, co-payments, 
        deductibles, co-insurance, or other out-of-pocket costs for 
        plan participants. Such payments shall not be used as general 
        revenues for an entity described in subsection (a)(2)(B)(i). 
        The Secretary shall develop a mechanism to monitor the 
        appropriate use of such payments by such entities.
            (5) Payments not treated as income.--Payments received 
        under this subsection shall not be included in determining the 
        gross income of an entity described in subsection (a)(2)(B)(i) 
        that is maintaining or currently contributing to a 
        participating employment-based plan.
            (6) Appeals.--The Secretary shall establish--
                    (A) an appeals process to permit participating 
                employment-based plans to appeal a determination of the 
                Secretary with respect to claims submitted under this 
                section; and
                    (B) procedures to protect against fraud, waste, and 
                abuse under the program.
    (d) Audits.--The Secretary shall conduct annual audits of claims 
data submitted by participating employment-based plans under this 
section to ensure that such plans are in compliance with the 
requirements of this section.
    (e) Retiree Reserve Trust Fund.--
            (1) Establishment of trust fund.--
                    (A) In general.--There is established in the 
                Treasury of the United States a trust fund to be known 
                as the ``Retiree Reserve Trust Fund'' (referred to in 
                this section as the ``Trust Fund''), that shall consist 
                of such amounts as may be appropriated or credited to 
                the Trust Fund as provided for in this subsection to 
                enable the Secretary to carry out the program under 
                this section. Such amounts shall remain available until 
                expended.
                    (B) Funding.--There are hereby appropriated to the 
                Trust Fund, out of any moneys in the Treasury not 
                otherwise appropriated an amount requested by the 
                Secretary of Health and Human Services as necessary to 
                carry out this section, except that the total of all 
                such amounts requested shall not exceed 
                $10,000,000,000.
                    (C) Appropriations from the trust fund.--Amounts in 
                the Trust Fund may be appropriated to provide funding 
                to carry out this program under this section
            (2) Use of trust fund.--The Secretary shall use amounts 
        contained in the Trust Fund to carry out the program under this 
        section.
            (3) Limitations.--The Secretary has the authority to stop 
        taking applications for participation in the program to comply 
        with the funding limit provided for in paragraph (1)(B).

  Subtitle G--Improving the Use of Health Information Technology for 
                  Enrollment; Miscellaneous Provisions

SEC. 185. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND 
              PROTOCOLS.

    Title XXX of the Public Health Service Act (42 U.S.C. 300jj et 
seq.) is amended by adding at the end the following:

                     ``Subtitle C--Other Provisions

``SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND 
              PROTOCOLS.

    ``(a) In General.--
            ``(1) Standards and protocols.--Not later than 180 days 
        after the date of enactment of this title, the Secretary, in 
        consultation with the HIT Policy Committee and the HIT 
        Standards Committee, shall develop interoperable and secure 
        standards and protocols that facilitate enrollment of 
        individuals in Federal and State health and human services 
        programs, as determined by the Secretary.
            ``(2) Methods.--The Secretary shall facilitate enrollment 
        in such programs through methods determined appropriate by the 
        Secretary, which shall include providing individuals and third 
        parties authorized by such individuals and their designees 
        notification of eligibility and verification of eligibility 
        required under such programs.
    ``(b) Content.--The standards and protocols for electronic 
enrollment in the Federal and State programs described in subsection 
(a) shall allow for the following:
            ``(1) Electronic matching against existing Federal and 
        State data, including vital records, employment history, 
        enrollment systems, tax records, and other data determined 
        appropriate by the Secretary to serve as evidence of 
        eligibility and in lieu of paper-based documentation.
            ``(2) Simplification and submission of electronic 
        documentation, digitization of documents, and systems 
        verification of eligibility.
            ``(3) Reuse of stored eligibility information (including 
        documentation) to assist with retention of eligible 
        individuals.
            ``(4) Capability for individuals to apply, recertify and 
        manage their eligibility information online, including at home, 
        at points of service, and other community-based locations.
            ``(5) Ability to expand the enrollment system to integrate 
        new programs, rules, and functionalities, to operate at 
        increased volume, and to apply streamlined verification and 
        eligibility processes to other Federal and State programs, as 
        appropriate.
            ``(6) Notification of eligibility, recertification, and 
        other needed communication regarding eligibility, which may 
        include communication via email and cellular phones.
            ``(7) Other functionalities necessary to provide eligibles 
        with streamlined enrollment process.
    ``(c) Approval and Notification.--With respect to any standard or 
protocol developed under subsection (a) that has been approved by the 
HIT Policy Committee and the HIT Standards Committee, the Secretary--
            ``(1) shall notify States of such standards or protocols; 
        and
            ``(2) may require, as a condition of receiving Federal 
        funds for the health information technology investments, that 
        States or other entities incorporate such standards and 
        protocols into such investments.
    ``(d) Grants for Implementation of Appropriate Enrollment HIT.--
            ``(1) In general.--The Secretary shall award grant to 
        eligible entities to develop new, and adapt existing, 
        technology systems to implement the HIT enrollment standards 
        and protocols developed under subsection (a) (referred to in 
        this subsection as `appropriate HIT technology').
            ``(2) Eligible entities.--To be eligible for a grant under 
        this subsection, an entity shall--
                    ``(A) be a State, political subdivision of a State, 
                or a local governmental entity; and
                    ``(B) submit to the Secretary an application at 
                such time, in such manner, and containing--
                            ``(i) a plan to adopt and implement 
                        appropriate enrollment technology that 
                        includes--
                                    ``(I) proposed reduction in 
                                maintenance costs of technology 
                                systems;
                                    ``(II) elimination or updating of 
                                legacy systems; and
                                    ``(III) demonstrated collaboration 
                                with other entities that may receive a 
                                grant under this section that are 
                                located in the same State, political 
                                subdivision, or locality;
                            ``(ii) an assurance that the entity will 
                        share such appropriate enrollment technology in 
                        accordance with paragraph (4); and
                            ``(iii) such other information as the 
                        Secretary may require.
            ``(3) Sharing.--
                    ``(A) In general.--The Secretary shall ensure that 
                appropriate enrollment HIT adopted under grants under 
                this subsection is made available to other qualified 
                State, qualified political subdivisions of a State, or 
                other appropriate qualified entities (as described in 
                subparagraph (B)) at no cost.
                    ``(B) Qualified entities.--The Secretary shall 
                determine what entities are qualified to receive 
                enrollment HIT under subparagraph (A), taking into 
                consideration the recommendations of the HIT Policy 
                Committee and the HIT Standards Committee.''.

SEC. 186. RULE OF CONSTRUCTION REGARDING HAWAII'S PREPAID HEALTH CARE 
              ACT.

    Nothing in this title (or an amendment made by this title) shall be 
construed to modify or limit the application of the exemption for 
Hawaii's Prepaid Health Care Act (Haw. Rev. Stat. Sec. Sec.  393-1 et 
seq.) as provided for under section 514(b)(5) of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)(5)).

SEC. 187. KEY NATIONAL INDICATORS.

    (a) Definitions.--In this section:
            (1) Academy.--The term ``Academy'' means the National 
        Academy of Sciences.
            (2) Commission.--The term ``Commission'' means the 
        Commission on Key National Indicators established under 
        subsection (b).
            (3) Institute.--The term ``Institute'' means a Key National 
        Indicators Institute as designated under subsection (c)(3).
    (b) Commission on Key National Indicators.--
            (1) Establishment.--There is established a ``Commission on 
        Key National Indicators''.
            (2) Membership.--
                    (A) Number and appointment.--The Commission shall 
                be composed of 8 members, to be appointed equally by 
                the majority and minority leaders of the Senate and the 
                Speaker and minority leader of the House of 
                Representatives.
                    (B) Prohibited appointments.--Members of the 
                Commission shall not include Members of Congress or 
                other elected Federal, State, or local government 
                officials.
                    (C) Qualifications.--In making appointments under 
                subparagraph (A), the majority and minority leaders of 
                the Senate and the Speaker and minority leader of the 
                House of Representatives shall appoint individuals who 
                have shown a dedication to improving civic dialogue and 
                decision-making through the wide use of scientific 
                evidence and factual information.
                    (D) Period of appointment.--Each member of the 
                Commission shall be appointed for a 2-year term, except 
                that 1 initial appointment shall be for 3 years. Any 
                vacancies shall not affect the power and duties of the 
                Commission but shall be filled in the same manner as 
                the original appointment and shall last only for the 
                remainder of that term.
                    (E) Date.--Members of the Commission shall be 
                appointed by not later than 30 days after the date of 
                enactment of this Act.
                    (F) Initial organizing period.---Not later than 60 
                days after the date of enactment of this Act, the 
                Commission shall develop and implement a schedule for 
                completion of the review and reports required under 
                subsection (d).
                    (G) Co-chairpersons.--The Commission shall select 2 
                Co-Chairpersons from among its members.
    (c) Duties of the Commission.--
            (1) In general.--The Commission shall--
                    (A) conduct comprehensive oversight of a newly 
                established key national indicators system consistent 
                with the purpose described in this subsection;
                    (B) make recommendations on how to improve the key 
                national indicators system;
                    (C) coordinate with Federal Government users and 
                information providers to assure access to relevant and 
                quality data; and
                    (D) enter into contracts with the Academy.
            (2) Reports.--
                    (A) Annual report to congress.--Not later than 1 
                year after the selection of the 2 Co-Chairpersons of 
                the Commission, and each subsequent year thereafter, 
                the Commission shall prepare and submit to the 
                appropriate Committees of Congress and the President a 
                report that contains a detailed statement of the 
                recommendations, findings, and conclusions of the 
                Commission on the activities of the Academy and a 
                designated Institute related to the establishment of a 
                Key National Indicator System.
                    (B) Annual report to the academy.--
                            (i) In general.--Not later than 6 months 
                        after the selection of the 2 Co-Chairpersons of 
                        the Commission, and each subsequent year 
                        thereafter, the Commission shall prepare and 
                        submit to the Academy and a designated 
                        Institute a report making recommendations 
                        concerning potential issue areas and key 
                        indicators to be included in the Key National 
                        Indicators.
                            (ii) Limitation.--The Commission shall not 
                        have the authority to direct the Academy or, if 
                        established, the Institute, to adopt, modify, 
                        or delete any key indicators.
            (3) Contract with the national academy of sciences.---
                    (A) In general.---As soon as practicable after the 
                selection of the 2 Co-Chairpersons of the Commission, 
                the Co-Chairpersons shall enter into an arrangement 
                with the National Academy of Sciences under which the 
                Academy shall--
                            (i) review available public and private 
                        sector research on the selection of a set of 
                        key national indicators;
                            (ii) determine how best to establish a key 
                        national indicator system for the United 
                        States, by either creating its own 
                        institutional capability or designating an 
                        independent private nonprofit organization as 
                        an Institute to implement a key national 
                        indicator system;
                            (iii) if the Academy designates an 
                        independent Institute under clause (ii), 
                        provide scientific and technical advice to the 
                        Institute and create an appropriate governance 
                        mechanism that balances Academy involvement and 
                        the independence of the Institute; and
                            (iv) provide an annual report to the 
                        Commission addressing scientific and technical 
                        issues related to the key national indicator 
                        system and, if established, the Institute, and 
                        governance of the Institute's budget and 
                        operations.
                    (B) Participation.--In executing the arrangement 
                under subparagraph (A), the National Academy of 
                Sciences shall convene a multi-sector, multi-
                disciplinary process to define major scientific and 
                technical issues associated with developing, 
                maintaining, and evolving a Key National Indicator 
                System and, if an Institute is established, to provide 
                it with scientific and technical advice.
                    (C) Establishment of a key national indicator 
                system.--
                            (i) In general.--In executing the 
                        arrangement under subparagraph (A), the 
                        National Academy of Sciences shall enable the 
                        establishment of a key national indicator 
                        system by--
                                    (I) creating its own institutional 
                                capability; or
                                    (II) partnering with an independent 
                                private nonprofit organization as an 
                                Institute to implement a key national 
                                indicator system.
                            (ii) Institute.--If the Academy designates 
                        an Institute under clause (i)(II), such 
                        Institute shall be a non-profit entity (as 
                        defined for purposes of section 501(c)(3) of 
                        the Internal Revenue Code of 1986) with an 
                        educational mission, a governance structure 
                        that emphasizes independence, and 
                        characteristics that make such entity 
                        appropriate for establishing a key national 
                        indicator system.
                            (iii) Responsibilities.--Either the Academy 
                        or the Institute designated under clause 
                        (i)(II) shall be responsible for the following:
                                    (I) Identifying and selecting issue 
                                areas to be represented by the key 
                                national indicators.
                                    (II) Identifying and selecting the 
                                measures used for key national 
                                indicators within the issue areas under 
                                subclause (I).
                                    (III) Identifying and selecting 
                                data to populate the key national 
                                indicators described under subclause 
                                (II).
                                    (IV) Designing, publishing, and 
                                maintaining a public website that 
                                contains a freely accessible database 
                                allowing public access to the key 
                                national indicators.
                                    (V) Developing a quality assurance 
                                framework to ensure rigorous and 
                                independent processes and the selection 
                                of quality data.
                                    (VI) Developing a budget for the 
                                construction and management of a 
                                sustainable, adaptable, and evolving 
                                key national indicator system that 
                                reflects all Commission funding of 
                                Academy and, if an Institute is 
                                established, Institute activities.
                                    (VII) Reporting annually to the 
                                Commission regarding its selection of 
                                issue areas, key indicators, data, and 
                                progress toward establishing a web-
                                accessible database.
                                    (VIII) Responding directly to the 
                                Commission in response to any 
                                Commission recommendations and to the 
                                Academy regarding any inquiries by the 
                                Academy.
                            (iv) Governance.--Upon the establishment of 
                        a key national indicator system, the Academy 
                        shall create an appropriate governance 
                        mechanism that incorporates advisory and 
                        control functions. If an Institute is 
                        designated under clause (i)(II), the governance 
                        mechanism shall balance appropriate Academy 
                        involvement and the independence of the 
                        Institute.
                            (v) Modification and changes.--The Academy 
                        shall retain the sole discretion, at any time, 
                        to alter its approach to the establishment of a 
                        key national indicator system or, if an 
                        Institute is designated under clause (i)(II), 
                        to alter any aspect of its relationship with 
                        the Institute or to designate a different non-
                        profit entity to serve as the Institute.
                            (vi) Construction.--Nothing in this section 
                        shall be construed to limit the ability of the 
                        Academy or the Institute designated under 
                        clause (i)(II) to receive private funding for 
                        activities related to the establishment of a 
                        key national indicator system.
                    (D) Annual report.--As part of the arrangement 
                under subparagraph (A), the National Academy of 
                Sciences shall, not later than 270 days after the date 
                of enactment of this Act, and annually thereafter, 
                submit to the Co-Chairpersons of the Commission a 
                report that contains the findings and recommendations 
                of the Academy.
    (d) Government Accountability Office Study and Report.--
            (1) GAO study.--The Comptroller General of the United 
        States shall conduct a study of previous work conducted by all 
        public agencies, private organizations, or foreign countries 
        with respect to best practices for a key national indicator 
        system. The study shall be submitted to the appropriate 
        authorizing committees of Congress.
            (2) GAO financial audit.--If an Institute is established 
        under this section, the Comptroller General shall conduct an 
        annual audit of the financial statements of the Institute, in 
        accordance with generally accepted government auditing 
        standards and submit a report on such audit to the Commission 
        and the appropriate authorizing committees of Congress.
            (3) GAO programmatic review.--The Comptroller General of 
        the United States shall conduct programmatic assessments of the 
        Institute established under this section as determined 
        necessary by the Comptroller General and report the findings to 
        the Commission and to the appropriate authorizing committees of 
        Congress.
    (e) Authorization of Appropriations.--
            (1) In general.---There are authorized to be appropriated 
        to carry out the purposes of this section, $10,000,000 for 
        fiscal year 2010, and $7,500,000 for each of fiscal year 2011 
        through 2018.
            (2) Availability.---Amounts appropriated under paragraph 
        (1) shall remain available until expended.

SEC. 188. STUDY AND REPORT ON RATES OF PREVENTABLE DISEASES IN NEW 
              MEDICARE ENROLLEES.

    (a) Study.--
            (1) In general.--The Comptroller General of the United 
        States (in this section referred to as the ``Comptroller 
        General'') shall conduct a study on--
                    (A) whether applicable new Medicare enrollees 
                exhibit higher than expected rates of preventable 
                disease when compared to the entire population of new 
                Medicare enrollees or another appropriate statistical 
                baseline; and
                    (B) if applicable new Medicare enrollees exhibit 
                such a higher than expected rate of preventable 
                disease, whether such rate is related to the failure of 
                the enrollee's previous private health insurance issuer 
                to promote, cover, or adequately pay for preventive 
                health benefits.
            (2) Applicable new medicare enrollee.--In this section, the 
        term ``applicable new Medicare enrollee'' means an individual--
                    (A) who is entitled to, or enrolled for, benefits 
                under part A of title XVII of the Social Security Act 
                (42 U.S.C. 1395 et seq.) or enrolled for benefits under 
                part B of such title on or after the date of enactment 
                of this Act; and
                    (B) who was covered by private health insurance or 
                Medicaid or other Federal Government health programs 
                (as of the day before the date of such entitlement or 
                enrollment).
    (b) Report.--Not later than 3 years after the date on which at 
least 5 Gateways under title XXXI of the Public Health Service Act, as 
added by section 142, are operating in the United States, the 
Comptroller General shall submit to Congress a report containing the 
results of the study conducted under subsection (a), together with 
recommendations for such legislation and administrative action as the 
Comptroller General determines appropriate.

SEC. 189. TRANSPARENCY IN GOVERNMENT.

    Not later than 30 days after the date of enactment of this Act, the 
Secretary of Health and Human Services shall publish on the Internet 
website of the Department of Health and Human Services, a list of all 
of the authorities provided to the Secretary under this Act (and the 
amendments made by this Act).

SEC. 189A. PRESERVING THE SOLVENCY OF MEDICARE AND SOCIAL SECURITY.

    Nothing in this Act (or an amendment made by this Act) shall be 
carried out in a manner that threatens the solvency of Medicare or 
Social Security programs.

SEC. 189B. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUICIDE.

    (a) In General.--The Federal Government, and any State or local 
government or health care provider that receives Federal financial 
assistance under this Act (or under an amendment made by this Act) or 
any health plan created under this Act (or under an amendment made by 
this Act), may not subject an individual or institutional health care 
entity to discrimination on the basis that the entity does not provide 
any health care item or service furnished for the purpose of causing, 
or for the purpose of assisting in causing, the death of any 
individual, such as by assisted suicide, euthanasia, or mercy killing.
    (b) Definition.--In this section, the term ``health care entity'' 
includes an individual physician or other health care professional, a 
hospital, a provider-sponsored organization, a health maintenance 
organization, a health insurance plan, or any other kind of health care 
facility, organization, or plan.
    (c) Construction and Treatment of Certain Services.--Nothing in 
subsection (a) shall be construed to apply to or to affect any 
limitation relating to--
            (1) the withholding or withdrawing of medical treatment or 
        medical care;
            (2) the withholding or withdrawing of nutrition or 
        hydration;
            (3) abortion; or
            (4) the use of an item, good, benefit, or service furnished 
        for the purpose of alleviating pain or discomfort, even if such 
        use may increase the risk of death, so long as such item, good, 
        benefit, or service is not also furnished for the purpose of 
        causing, or the purpose of assisting in causing, death, for any 
        reason.
    (d) Administration.--The Office for Civil Rights of the Department 
of Health and Human Services is designated to receive complaints of 
discrimination based on this section.

SEC. 189C. ACCESS TO THERAPIES.

    Notwithstanding any other provision of the Affordable Health 
Choices Act, the Secretary of Health and Human Services shall not 
promulgate any regulation that--
            (1) creates any unreasonable barriers to the ability of 
        individuals to obtain appropriate medical care;
            (2) impedes timely access to health care services;
            (3) interferes with communications regarding a full range 
        of treatment options between the patient and the provider;
            (4) restricts the ability of health care providers to 
        provide full disclosure of all relevant information to patients 
        making health care decisions;
            (5) violates the principles of informed consent and the 
        ethical standards of health care professionals; or
            (6) limits the availability of health care treatment for 
        the full duration of a patient's medical needs.

SEC. 189D. FREEDOM NOT TO PARTICIPATE IN FEDERAL HEALTH INSURANCE 
              PROGRAMS.

    No individual, company, business, nonprofit entity, or health 
insurer offering group or individual health insurance shall be required 
to participate in any Federal health insurance program created under 
this Act (or any amendments made by this Act), or in any Federal health 
insurance program expanded by this Act (or any such amendments), and 
there shall be no penalty or fine imposed upon any such insurer for 
choosing not to participate in such programs.

                         Subtitle H--CLASS Act

SEC. 190. SHORT TITLE OF SUBTITLE.

    This subtitle may be cited as the ``Community Living Assistance 
Services and Supports Act'' or the ``CLASS Act''.

SEC. 191. ESTABLISHMENT OF NATIONAL VOLUNTARY INSURANCE PROGRAM FOR 
              PURCHASING COMMUNITY LIVING ASSISTANCE SERVICES AND 
              SUPPORT.

    (a) Establishment of CLASS Program.--
            (1) In general.--The Public Health Service Act (42 U.S.C. 
        201 et seq.), as amended by section 143, is amended by adding 
        at the end the following:

    ``TITLE XXXII--COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS

``SEC. 3201. PURPOSE.

    ``The purpose of this title is to establish a national voluntary 
insurance program for purchasing community living assistance services 
and supports in order to--
            ``(1) provide individuals with functional limitations with 
        tools that will allow them to maintain their personal and 
        financial independence and live in the community through a new 
        financing strategy for community living assistance services and 
        supports;
            ``(2) establish an infrastructure that will help address 
        the Nation's community living assistance services and supports 
        needs;
            ``(3) alleviate burdens on family caregivers; and
            ``(4) address institutional bias by providing a financing 
        mechanism that supports personal choice and independence to 
        live in the community.

``SEC. 3202. DEFINITIONS.

    ``In this title:
            ``(1) Active enrollee.--The term `active enrollee' means an 
        individual who is enrolled in the CLASS program in accordance 
        with section 3204 and who has paid any premiums due to maintain 
        such enrollment.
            ``(2) Actively employed.--The term `actively employed' 
        means an individual who--
                    ``(A) is reporting for work at the individual's 
                usual place of employment or at another location to 
                which the individual is required to travel because of 
                the individual's employment (or in the case of an 
                individual who is a member of the uniformed services, 
                is on active duty and is physically able to perform the 
                duties of the individual's position); and
                    ``(B) is able to perform all the usual and 
                customary duties of the individual's employment on the 
                individual's regular work schedule.
            ``(3) Activities of daily living.--The term `activities of 
        daily living' means each of the following activities specified 
        in section 7702B(c)(2)(B) of the Internal Revenue Code of 1986:
                    ``(A) Eating.
                    ``(B) Toileting.
                    ``(C) Transferring.
                    ``(D) Bathing.
                    ``(E) Dressing.
                    ``(F) Continence.
            ``(4) CLASS program.--The term `CLASS program' means the 
        program established under this title.
            ``(5) Disability determination service.--The term 
        `Disability Determination Service' means, with respect to each 
        State, the entity that has an agreement with the Commissioner 
        of Social Security to make disability determinations for 
        purposes of title II or XVI of the Social Security Act (42 
        U.S.C. 401 et seq., 1381 et seq.).
            ``(6) Eligible beneficiary.--
                    ``(A) In general.--The term `eligible beneficiary' 
                means any individual who is an active enrollee in the 
                CLASS program and, as of the date described in 
                subparagraph (B)--
                            ``(i) has paid premiums for enrollment in 
                        such program for at least 60 months;
                            ``(ii) has earned, for each calendar year 
                        that occurs during the first 60 months for 
                        which the individual has paid premiums for 
                        enrollment in the program, at least an amount 
                        equal to the amount of wages and self-
                        employment income which an individual must have 
                        in order to be credited with a quarter of 
                        coverage under section 213(d) of the Social 
                        Security Act for that year; and
                            ``(iii) has paid premiums for enrollment in 
                        such program for at least 24 consecutive 
                        months, if a lapse in premium payments of more 
                        than 3 months has occurred during the period 
                        that begins on the date of the individual's 
                        enrollment and ends on the date of such 
                        determination.
                    ``(B) Date described.--For purposes of subparagraph 
                (A), the date described in this subparagraph is the 
                date on which the individual is determined to have a 
                functional limitation described in section 
                3203(a)(1)(C) that is expected to last for a continuous 
                period of more than 90 days.
                    ``(C) Regulations.--The Secretary shall promulgate 
                regulations specifying exceptions to the minimum 
                earnings requirements under subparagraph (A)(ii) for 
                purposes of being considered an eligible beneficiary 
                for certain populations.
            ``(7) Hospital; nursing facility; intermediate care 
        facility for the mentally retarded; institution for mental 
        diseases.--The terms `hospital', `nursing facility', 
        `intermediate care facility for the mentally retarded', and 
        `institution for mental diseases' have the meanings given such 
        terms for purposes of Medicaid.
            ``(8) CLASS independence advisory council.--The term `CLASS 
        Independence Advisory Council' or `Council' means the Advisory 
        Council established under section 3207 to advise the Secretary.
            ``(9) CLASS independence benefit plan.--The term `CLASS 
        Independence Benefit Plan' means the benefit plan developed and 
        designated by the Secretary in accordance with section 3203.
            ``(10) CLASS independence fund.--The term `CLASS 
        Independence Fund' or `Fund' means the fund established under 
        section 3206.
            ``(11) Medicaid.--The term `Medicaid' means the program 
        established under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
            ``(12) Protection and advocacy system.--The term 
        `Protection and Advocacy System' means the system for each 
        State established under section 143 of the Developmental 
        Disabilities Assistance and Bill of Rights Act of 2000 (42 
        U.S.C. 15043).

``SEC. 3203. CLASS INDEPENDENCE BENEFIT PLAN.

    ``(a) Process for Development.--
            ``(1) In general.--The Secretary, in consultation with 
        appropriate actuaries and other experts, shall develop at least 
        3 actuarially sound benefit plans as alternatives for 
        consideration for designation by the Secretary as the CLASS 
        Independence Benefit Plan under which eligible beneficiaries 
        shall receive benefits under this title. Each of the plan 
        alternatives developed shall be designed to provide eligible 
        beneficiaries with the benefits described in section 3205 
        consistent with the following requirements:
                    ``(A) Premiums.--Beginning with the first year of 
                the CLASS program, and for each year thereafter, the 
                Secretary shall establish all premiums to be paid by 
                enrollees for the year based on an actuarial analysis 
                of the 75-year costs of the program that ensures 
                solvency throughout such 75-year period.
                    ``(B) Vesting period.--A 5-year vesting period for 
                eligibility for benefits.
                    ``(C) Benefit triggers.--A benefit trigger for 
                provision of benefits that requires a determination 
                that an individual has a functional limitation, as 
                certified by a licensed health care practitioner, 
                described in any of the following clauses that is 
                expected to last for a continuous period of more than 
                90 days:
                            ``(i) The individual is determined to be 
                        unable to perform at least the minimum number 
                        (which may be 2 or 3) of activities of daily 
                        living as are required under the plan for the 
                        provision of benefits without substantial 
                        assistance (as defined by the Secretary) from 
                        another individual.
                            ``(ii) The individual requires substantial 
                        supervision to protect the individual from 
                        threats to health and safety due to substantial 
                        cognitive impairment.
                            ``(iii) The individual has a level of 
                        functional limitation similar (as determined 
                        under regulations prescribed by the Secretary) 
                        to the level of functional limitation described 
                        in clause (i) or (ii).
                    ``(D) Cash benefit.--Payment of a cash benefit that 
                satisfies the following requirements:
                            ``(i) Minimum required amount.--The benefit 
                        amount provides an eligible beneficiary with 
                        not less than an average of $50 per day (as 
                        determined based on the reasonably expected 
                        distribution of beneficiaries receiving 
                        benefits at various benefit levels).
                            ``(ii) Amount scaled to functional 
                        ability.--The benefit amount is varied based on 
                        a scale of functional ability, with not less 
                        than 2, and not more than 6, benefit level 
                        amounts.
                            ``(iii) Daily or weekly.--The benefit is 
                        paid on a daily or weekly basis.
                            ``(iv) No lifetime or aggregate limit.--The 
                        benefit is not subject to any lifetime or 
                        aggregate limit.
                    ``(E) Coordination with supplemental coverage 
                obtained through the exchange.--The benefits allow for 
                coordination with any supplemental coverage purchased 
                through a Gateway established under section 3101.
            ``(2) Review and recommendation by the class independence 
        advisory council.--The CLASS Independence Advisory Council 
        shall--
                    ``(A) evaluate the alternative benefit plans 
                developed under paragraph (1); and
                    ``(B) recommend for designation as the CLASS 
                Independence Benefit Plan for offering to the public 
                the plan that the Council determines best balances 
                price and benefits to meet enrollees' needs in an 
                actuarially sound manner, while optimizing the 
                probability of the long-term sustainability of the 
                CLASS program.
            ``(3) Designation by the secretary.--Not later than October 
        1, 2012, the Secretary, taking into consideration the 
        recommendation of the CLASS Independence Advisory Council under 
        paragraph (2)(B), shall designate a benefit plan as the CLASS 
        Independence Benefit Plan. The Secretary shall publish such 
        designation, along with details of the plan and the reasons for 
        the selection by the Secretary, in a final rule that allows for 
        a period of public comment.
    ``(b) Additional Premium Requirements.--
            ``(1) Adjustment of premiums.--
                    ``(A) In general.--Except as provided in 
                subparagraphs (B), (C), (D), and (E), the amount of the 
                monthly premium determined for an individual upon such 
                individual's enrollment in the CLASS program shall 
                remain the same for as long as the individual is an 
                active enrollee in the program.
                    ``(B) Recalculated premium if required for program 
                solvency.--
                            ``(i) In general.--Subject to clause (ii), 
                        if the Secretary determines, based on the most 
                        recent report of the Board of Trustees of the 
                        CLASS Independence Fund, the advice of the 
                        CLASS Independence Advisory Council, and the 
                        annual report of the Inspector General of the 
                        Department of Health and Human Services, and 
                        waste, fraud, and abuse, or such other 
                        information as the Secretary determines 
                        appropriate, that the monthly premiums and 
                        income to the CLASS Independence Fund for a 
                        year are projected to be insufficient with 
                        respect to the 20-year period that begins with 
                        that year, the Secretary shall adjust the 
                        monthly premiums for individuals enrolled in 
                        the CLASS program as necessary.
                            ``(ii) Exemption from increase.--Any 
                        increase in a monthly premium imposed as result 
                        of a determination described in clause (i) 
                        shall not apply with respect to the monthly 
                        premium of any active enrollee who--
                                    ``(I) has attained age 65;
                                    ``(II) has paid premiums for 
                                enrollment in the program for at least 
                                20 years; and
                                    ``(III) is not actively employed.
                    ``(C) Recalculated premium if reenrollment after 
                more than a 3-month lapse.--
                            ``(i) In general.--The reenrollment of an 
                        individual after a 90-day period during which 
                        the individual failed to pay the monthly 
                        premium required to maintain the individual's 
                        enrollment in the CLASS program shall be 
                        treated as an initial enrollment for purposes 
                        of age-adjusting the premium for enrollment in 
                        the program.
                            ``(ii) Credit for prior months if 
                        reenrolled within 5 years.--An individual who 
                        reenrolls in the CLASS program after such a 90-
                        day period and before the end of the 5-year 
                        period that begins with the first month for 
                        which the individual failed to pay the monthly 
                        premium required to maintain the individual's 
                        enrollment in the program shall be--
                                    ``(I) credited with any months of 
                                paid premiums that accrued prior to the 
                                individual's lapse in enrollment; and
                                    ``(II) notwithstanding the total 
                                amount of any such credited months, 
                                required to satisfy section 
                                3202(6)(A)(ii) before being eligible to 
                                receive benefits.
                    ``(D) Penalty for reenollment after 5-year lapse.--
                In the case of an individual who reenrolls in the CLASS 
                program after the end of the 5-year period described in 
                subparagraph (C)(ii), the monthly premium required for 
                the individual shall be the age-adjusted premium that 
                would be applicable to an initially enrolling 
                individual who is the same age as the reenrolling 
                individual, increased by the greater of--
                            ``(i) an amount that the Secretary 
                        determines is actuarially sound for each month 
                        that occurs during the period that begins with 
                        the first month for which the individual failed 
                        to pay the monthly premium required to maintain 
                        the individual's enrollment in the CLASS 
                        program and ends with the month preceding the 
                        month in which the reenollment is effective; or
                            ``(ii) 1 percent of the applicable age-
                        adjusted premium for each such month occurring 
                        in such period.
            ``(2) Administrative expenses.--In determining the monthly 
        premiums for the CLASS program the Secretary, in coordination 
        with the Commissioner of Social Security, may factor in costs 
        for administering the program, not to exceed--
                    ``(A) in the case of the first 5 years in which the 
                program is in effect under this title, an amount equal 
                to 3 percent of all premiums paid during each such 
                year; and
                    ``(B) in the case of subsequent years, an amount 
                equal to 5 percent of the total amount of all 
                expenditures (including benefits paid) under this title 
                with respect to that year.
            ``(3) No underwriting requirements.--No underwriting (other 
        than on the basis of age in accordance with paragraph (2)) 
        shall be used to--
                    ``(A) determine the monthly premium for enrollment 
                in the CLASS program; or
                    ``(B) prevent an individual from enrolling in the 
                program.

``SEC. 3204. ENROLLMENT AND DISENROLLMENT REQUIREMENTS.

    ``(a) Automatic Enrollment.--
            ``(1) In general.--Subject to paragraph (2), the Secretary, 
        in coordination with the Secretary of the Treasury, shall 
        establish procedures under which each individual described in 
        subsection (c) shall be automatically enrolled in the CLASS 
        program by an employer of such individual in the same manner as 
        an employer may elect to automatically enroll employees in a 
        plan under section 401(k), 403(b), or 457 of the Internal 
        Revenue Code of 1986.
            ``(2) Alternative enrollment procedures.--The procedures 
        established under paragraph (1) shall provide for an 
        alternative enrollment process for an individual described in 
        subsection (c) in the case of such an individual--
                    ``(A) who is self-employed;
                    ``(B) who has more than 1 employer;
                    ``(C) whose employer does not elect to participate 
                in the automatic enrollment process established by the 
                Secretary; or
                    ``(D) who is a spouse described in subsection 
                (c)(2) of who is not subject to automatic enrollment.
            ``(3) Administration.--
                    ``(A) In general.--The Secretary and the Secretary 
                of the Treasury shall, by regulation, establish 
                procedures to--
                            ``(i) ensure that an individual is not 
                        automatically enrolled in the CLASS program by 
                        more than 1 employer; and
                            ``(ii) allow for an individual's employer 
                        to deduct a premium for a spouse described in 
                        subsection (c)(1)(B) who is not subject to 
                        automatic enrollment.
                    ``(B) Form.--Enrollment in the CLASS program shall 
                be made in such manner as the Secretary may prescribe 
                in order to ensure ease of administration.
    ``(b) Election to Opt-out.--An individual described in subsection 
(c) may elect to waive enrollment in the CLASS program at any time in 
such form and manner as the Secretary and the Secretary of the Treasury 
shall prescribe.
    ``(c) Individual Described.--For purposes of enrolling in the CLASS 
program, an individual described in this paragraph is--
            ``(1) an individual--
                    ``(A) who has attained age 18;
                    ``(B) who--
                            ``(i) receives wages on which there is 
                        imposed a tax under section 3201(a) of the 
                        Internal Revenue Code of 1986; or
                            ``(ii) derives self-employment income on 
                        which there is imposed a tax under section 
                        1401(a) of the Internal Revenue Code of 1986;
                    ``(C) who is actively employed; and
                    ``(D) who is not--
                            ``(i) a patient in a hospital or nursing 
                        facility, an intermediate care facility for the 
                        mentally retarded, or an institution for mental 
                        diseases and receiving medical assistance under 
                        Medicaid; or
                            ``(ii) confined in a jail, prison, other 
                        penal institution or correctional facility, or 
                        by court order pursuant to conviction of a 
                        criminal offense or in connection with a 
                        verdict or finding described in section 
                        202(x)(1)(A)(ii) of the Social Security Act (42 
                        U.S.C. 402(x)(1)(A)(ii)); or
            ``(2) the spouse of an individual described in paragraph 
        (1) and who would be an individual so described but for 
        subparagraph (B) or (C) of that paragraph.
    ``(d) Rule of Construction.--Nothing in this title shall be 
construed as requiring an active enrollee to continue to satisfy 
subparagraph (B) or (C) of subsection (c)(1) in order to maintain 
enrollment in the CLASS program.
    ``(e) Payment.--
            ``(1) Payroll deduction.--An amount equal to the monthly 
        premium for the enrollment in the CLASS program of an 
        individual shall be deducted from the wages or self-employment 
        income of such individual in accordance with such procedures as 
        the Secretary, in coordination with the Secretary of the 
        Treasury, shall establish for employers who elect to deduct and 
        withhold such premiums on behalf of enrolled employees.
            ``(2) Alternative payment mechanism.--The Secretary, in 
        coordination with the Secretary of the Treasury, shall 
        establish alternative procedures for the payment of monthly 
        premiums by an individual enrolled in the CLASS program--
                    ``(A) who does not have an employer who elects to 
                deduct and withhold premiums in accordance with 
                subparagraph (A); or
                    ``(B) who does not earn wages or derive self-
                employment income.
    ``(f) Transfer of Premiums Collected.--
            ``(1) In general.--During each calendar year the Secretary 
        of the Treasury shall deposit into the CLASS Independence Fund 
        a total amount equal, in the aggregate, to 100 percent of the 
        premiums collected during that year.
            ``(2) Transfers based on estimates.--The amount deposited 
        pursuant to paragraph (1) shall be transferred in at least 
        monthly payments to the CLASS Independence Fund on the basis of 
        estimates by the Secretary and certified to the Secretary of 
        the Treasury of the amounts collected in accordance with 
        subparagraphs (A) and (B) of paragraph (5). Proper adjustments 
        shall be made in amounts subsequently transferred to the Fund 
        to the extent prior estimates were in excess of, or were less 
        than, actual amounts collected.
    ``(g) Other Enrollment and Disenrollment Opportunities.--The 
Secretary, in coordination with the Secretary of the Treasury, shall 
establish procedures under which--
            ``(1) an individual who, in the year of the individual's 
        initial eligibility to enroll in the CLASS program, has elected 
        to waive enrollment in the program, is eligible to elect to 
        enroll in the program, in such form and manner as the 
        Secretaries shall establish, only during an open enrollment 
        period established by the Secretaries that is specific to the 
        individual and that may not occur more frequently than 
        biennially after the date on which the individual first elected 
        to waive enrollment in the program; and
            ``(2) an individual shall only be permitted to disenroll 
        from the program during an annual disenrollment period 
        established by the Secretaries and in such form and manner as 
        the Secretaries shall establish.

``SEC. 3205. BENEFITS.

    ``(a) Determination of Eligibility.--
            ``(1) Application for receipt of benefits.--The Secretary, 
        in coordination with the Commissioner of Social Security, shall 
        establish procedures under which an active enrollee shall apply 
        for receipt of benefits under the CLASS Independence Benefit 
        Plan.
            ``(2) Eligibility assessments.--
                    ``(A) In general.--Not later than January 1, 2012, 
                the Secretary shall enter into agreements with--
                            ``(i) the Disability Determination Service 
                        for each State to provide for eligibility 
                        assessments of active enrollees who apply for 
                        receipt of benefits;
                            ``(ii) the Protection and Advocacy System 
                        for each State to provide advocacy services in 
                        accordance with subsection (d); and
                            ``(iii) public and private entities to 
                        provide advice and assistance counseling in 
                        accordance with subsection (e).
                    ``(B) Regulations.--The Secretary, in coordination 
                with the Commissioner of Social Security, shall 
                promulgate regulations to develop an expedited 
                eligibility determination process, as certified by a 
                licensed health care practitioner, an appeals process, 
                and a redetermination process, as certified by a 
                licensed health care practitioner, including whether an 
                applicant is eligible for a cash benefit under the 
                program and if so, the amount of the cash benefit (in 
                accordance the sliding scale established under the 
                plan).
                    ``(C) Presumptive eligibility for certain 
                institutionalized enrollees planning to discharge.--An 
                active enrollee shall be deemed presumptively eligible 
                if the enrollee--
                            ``(i) has applied for, and attests is 
                        eligible for, the maximum cash benefit 
                        available under the sliding scale established 
                        under the CLASS Independence Benefit Plan;
                            ``(ii) is a patient in a hospital (but only 
                        if the hospitalization is for long-term care), 
                        nursing facility, intermediate care facility 
                        for the mentally retarded, or an institution 
                        for mental diseases; and
                            ``(iii) is in the process of, or about to 
                        being the process of, planning to discharge 
                        from the hospital, facility, or institution, or 
                        within 60 days from the date of discharge from 
                        the hospital, facility, or institution.
                    ``(D) Appeals.--The Secretary shall establish 
                procedures under which an applicant for benefits under 
                the CLASS Independence Benefit Plan shall be guaranteed 
                the right to appeal an adverse determination.
    ``(b) Benefits.--An eligible beneficiary shall receive the 
following benefits under the CLASS Independence Benefit Plan:
            ``(1) Cash benefit.--A cash benefit established by the 
        Secretary in accordance with the requirements of section 
        3203(a)(1)(D) that--
                    ``(A) the first year in which beneficiaries receive 
                the benefits under the plan, is not less than the 
                average dollar amount specified in clause (i) of such 
                section; and
                    ``(B) for any subsequent year, is not less than the 
                average per day dollar limit applicable under this 
                subparagraph for the preceding year, increased by the 
                percentage increase in the consumer price index for all 
                urban consumers (U.S. city average) over the previous 
                year.
            ``(2) Advocacy services.--Advocacy services in accordance 
        with subsection (d).
            ``(3) Advice and assistance counseling.--Advice and 
        assistance counseling in accordance with subsection (e).
            ``(4) Administrative expenses.--Advocacy services and 
        advise and assistance counseling services under paragraphs (2) 
        and (3) of this subsection shall be included as administrative 
        expenses under section 3203(b)(3).
    ``(c) Payment of Benefits.--
            ``(1) Life independence account.--
                    ``(A) In general.--The Secretary shall establish 
                procedures for administering the provision of benefits 
                to eligible beneficiaries under the CLASS Independence 
                Benefit Plan, including the payment of the cash benefit 
                for the beneficiary into a Life Independence Account 
                established by the Secretary on behalf of each eligible 
                beneficiary.
                    ``(B) Use of cash benefits.--Cash benefits paid 
                into a Life Independence Account of an eligible 
                beneficiary shall be used to purchase nonmedical 
                services and supports that the beneficiary needs to 
                maintain his or her independence at home or in another 
                residential setting of their choice in the community, 
                including (but not limited to) home modifications, 
                assistive technology, accessible transportation, 
                homemaker services, respite care, personal assistance 
                services, home care aides, and nursing support. Nothing 
                in the preceding sentence shall prevent an eligible 
                beneficiary from using cash benefits paid into a Life 
                Independence Account for obtaining assistance with 
                decision making concerning medical care, including the 
                right to accept or refuse medical or surgical treatment 
                and the right to formulate advance directives or other 
                written instructions recognized under State law, such 
                as a living will or durable power of attorney for 
                health care, in the case that an injury or illness 
                causes the individual to be unable to make health care 
                decisions.
                    ``(C) Electronic management of funds.--The 
                Secretary shall establish procedures for--
                            ``(i) crediting an account established on 
                        behalf of a beneficiary with the beneficiary's 
                        cash daily benefit;
                            ``(ii) allowing the beneficiary to access 
                        such account through debit cards; and
                            ``(iii) accounting for withdrawals by the 
                        beneficiary from such account.
                    ``(D) Primary payor rules for beneficiaries who are 
                enrolled in medicaid.--In the case of an eligible 
                beneficiary who is enrolled in Medicaid, the following 
                payment rules shall apply:
                            ``(i) Institutionalized beneficiary.--If 
                        the beneficiary is a patient in a hospital, 
                        nursing facility, intermediate care facility 
                        for the mentally retarded, or an institution 
                        for mental diseases, the beneficiary shall 
                        retain an amount equal to 5 percent of the 
                        beneficiary's daily or weekly cash benefit (as 
                        applicable) (which shall be in addition to the 
                        amount of the beneficiary's personal needs 
                        allowance provided under Medicaid), and the 
                        remainder of such benefit shall be applied 
                        toward the facility's cost of providing the 
                        beneficiary's care, and Medicaid shall provide 
                        secondary coverage for such care.
                            ``(ii) Beneficiaries receiving home and 
                        community-based services.--
                                    ``(I) 50 percent of benefit 
                                retained by beneficiary.--Subject to 
                                subclause (II), if a beneficiary is 
                                receiving medical assistance under 
                                Medicaid for home and community based 
                                services, the beneficiary shall retain 
                                an amount equal to 50 percent of the 
                                beneficiary's daily or weekly cash 
                                benefit (as applicable), and the 
                                remainder of the daily or weekly cash 
                                benefit shall be applied toward the 
                                cost to the State of providing such 
                                assistance (and shall not be used to 
                                claim Federal matching funds under 
                                Medicaid), and Medicaid shall provide 
                                secondary coverage for the remainder of 
                                any costs incurred in providing such 
                                assistance.
                                    ``(II) Requirement for state 
                                offset.--A State shall be paid the 
                                remainder of a beneficiary's daily or 
                                weekly cash benefit under subclause (I) 
                                only if the State home and community-
                                based waiver under section 1115 of the 
                                Social Security Act (42 U.S.C. 1315) or 
                                subsection (c) or (d) of section 1915 
                                of such Act (42 U.S.C. 1396n), or the 
                                State plan amendment under subsection 
                                (i) of such section does not include a 
                                waiver of the requirements of section 
                                1902(a)(1) of the Social Security Act 
                                (relating to statewideness) or of 
                                section 1902(a)(10)(B) of such Act 
                                (relating to comparability) and the 
                                State offers at a minimum case 
                                management services, personal care 
                                services, habilitation services, and 
                                respite care under such a waiver or 
                                State plan amendment.
                                    ``(III) Definition of home and 
                                community-based services.--In this 
                                clause, the term `home and community-
                                based services' means any services 
                                which may be offered under a home and 
                                community-based waiver authorized for a 
                                State under section 1115 of the Social 
                                Security Act (42 U.S.C. 1315) or 
                                subsection (c) or (d) of section 1915 
                                of such Act (42 U.S.C. 1396n) or under 
                                a State plan amendment under subsection 
                                (i) of such section.
                            ``(iii) Beneficiaries enrolled in programs 
                        of all-inclusive care for the elderly (pace).--
                                    ``(I) In general.--Subject to 
                                subclause (II), if a beneficiary is 
                                receiving medical assistance under 
                                Medicaid for PACE program services 
                                under section 1934 of the Social 
                                Security Act (42 U.S.C. 1396u-4), the 
                                beneficiary shall retain an amount 
                                equal to 50 percent of the 
                                beneficiary's daily or weekly cash 
                                benefit (as applicable), and the 
                                remainder of the daily or weekly cash 
                                benefit shall be applied toward the 
                                cost to the State of providing such 
                                assistance (and shall not be used to 
                                claim Federal matching funds under 
                                Medicaid), and Medicaid shall provide 
                                secondary coverage for the remainder of 
                                any costs incurred in providing such 
                                assistance.
                                    ``(II) Institutionalized recipients 
                                of pace program services.--If a 
                                beneficiary receiving assistance under 
                                Medicaid for PACE program services is a 
                                patient in a hospital, nursing 
                                facility, intermediate care facility 
                                for the mentally retarded, or an 
                                institution for mental diseases, the 
                                beneficiary shall be treated as in 
                                institutionalized beneficiary under 
                                clause (i).
            ``(2) Authorized representatives.--
                    ``(A) In general.--The Secretary shall establish 
                procedures to allow access to a beneficiary's cash 
                benefits by an authorized representative of the 
                eligible beneficiary on whose behalf such benefits are 
                paid.
                    ``(B) Quality assurance and protection against 
                fraud and abuse.--The procedures established under 
                subparagraph (A) shall ensure that authorized 
                representatives of eligible beneficiaries comply with 
                standards of conduct established by the Secretary, 
                including standards requiring that such representatives 
                provide quality services on behalf of such 
                beneficiaries, do not have conflicts of interest, and 
                do not misuse benefits paid on behalf of such 
                beneficiaries or otherwise engage in fraud or abuse.
            ``(3) Commencement of benefits.--Benefits shall be paid to, 
        or on behalf of, an eligible beneficiary beginning with the 
        first month in which an application for such benefits is 
        approved.
            ``(4) Rollover option for lump-sum payment.--An eligible 
        beneficiary may elect to--
                    ``(A) defer payment of their daily or weekly 
                benefit and to rollover any such deferred benefits from 
                month-to-month, but not from year-to-year; and
                    ``(B) receive a lump-sum payment of such deferred 
                benefits in an amount that may not exceed the lesser 
                of--
                            ``(i) the total amount of the accrued 
                        deferred benefits; or
                            ``(ii) the applicable annual benefit.
            ``(5) Period for determination of annual benefits.--
                    ``(A) In general.--The applicable period for 
                determining with respect to an eligible beneficiary the 
                applicable annual benefit and the amount of any accrued 
                deferred benefits is the 12-month period that commences 
                with the first month in which the beneficiary began to 
                receive such benefits, and each 12-month period 
                thereafter.
                    ``(B) Inclusion of increased benefits.--The 
                Secretary shall establish procedures under which cash 
                benefits paid to an eligible beneficiary that increase 
                or decrease as a result of a change in the functional 
                status of the beneficiary before the end of a 12-month 
                benefit period shall be included in the determination 
                of the applicable annual benefit paid to the eligible 
                beneficiary.
                    ``(C) Recoupment of unpaid, accrued benefits.--
                            ``(i) In general.--The Secretary, in 
                        coordination with the Secretary of the 
                        Treasury, shall recoup any accrued benefits in 
                        the event of--
                                    ``(I) the death of a beneficiary; 
                                or
                                    ``(II) the failure of a beneficiary 
                                to elect under paragraph (4)(B) to 
                                receive such benefits as a lump-sum 
                                payment before the end of the 12-month 
                                period in which such benefits accrued.
                            ``(ii) Payment into class independence 
                        fund.--Any benefits recouped in accordance with 
                        clause (i) shall be paid into the CLASS 
                        Independence Fund and used in accordance with 
                        section 3206.
            ``(6) Requirement to recertify eligibility for receipt of 
        benefits.--An eligible beneficiary shall periodically, as 
        determined by the Secretary, in coordination with the 
        Commissioner of Social Security--
                    ``(A) recertify by submission of medical evidence 
                the beneficiary's continued eligibility for receipt of 
                benefits; and
                    ``(B) submit records of expenditures attributable 
                to the aggregate cash benefit received by the 
                beneficiary during the preceding year.
            ``(7) Supplement, not supplant other health care 
        benefits.--Subject to the Medicaid payment rules under 
        paragraph (1)(D), benefits received by an eligible beneficiary 
        shall supplement, but not supplant, other health care benefits 
        for which the beneficiary is eligible under Medicaid or any 
        other Federally funded program that provides health care 
        benefits or assistance.
    ``(d) Advocacy Services.--An agreement entered into under 
subsection (a)(2)(A)(ii) shall require the Protection and Advocacy 
System for the State to--
            ``(1) assign, as needed, an advocacy counselor to each 
        eligible beneficiary that is covered by such agreement and who 
        shall provide an eligible beneficiary with--
                    ``(A) information regarding how to access the 
                appeals process established for the program;
                    ``(B) assistance with respect to the annual 
                recertification and notification required under 
                subsection (c)(6); and
                    ``(C) such other assistance with obtaining services 
                as the Secretary, by regulation, shall require; and
            ``(2) ensure that the System and such counselors comply 
        with the requirements of subsection (h).
    ``(e) Advice and Assistance Counseling.--An agreement entered into 
under subsection (a)(2)(A)(iii) shall require the entity to assign, as 
requested by an eligible beneficiary that is covered by such agreement, 
an advice and assistance counselor who shall provide an eligible 
beneficiary with information regarding--
            ``(1) accessing and coordinating long-term services and 
        supports in the most integrated setting;
            ``(2) possible eligibility for other benefits and services;
            ``(3) development of a service and support plan;
            ``(4) information about programs established under the 
        Assistive Technology Act of 1998 and the services offered under 
        such programs;
            ``(5) available assistance with decision making concerning 
        medical care, including the right to accept or refuse medical 
        or surgical treatment and the right to formulate advance 
        directives or other written instructions recognized under State 
        law, such as a living will or durable power of attorney for 
        health care, in the case that an injury or illness causes the 
        individual to be unable to make health care decisions; and
            ``(6) such other services as the Secretary, by regulation, 
        may require.
    ``(f) No Effect on Eligibility for Other Benefits.--Benefits paid 
to an eligible beneficiary under the CLASS program shall be disregarded 
for purposes of determining or continuing the beneficiary's eligibility 
for receipt of benefits under any other Federal, State, or locally 
funded assistance program, including benefits paid under titles II, 
XVI, XVIII, XIX, or XXI of the Social Security Act (42 U.S.C. 401 et 
seq., 1381 et seq., 1395 et seq., 1396 et seq., 1397aa et seq.), under 
the laws administered by the Secretary of Veterans Affairs, under low-
income housing assistance programs, or under the supplemental nutrition 
assistance program established under the Food and Nutrition Act of 2008 
(7 U.S.C. 2011 et seq.).
    ``(g) Rule of Construction.--Nothing in this title shall be 
construed as prohibiting benefits paid under the CLASS Independence 
Benefit Plan from being used to compensate a family caregiver for 
providing community living assistance services and supports to an 
eligible beneficiary.
    ``(h) Protection Against Conflict of Interests.--The Secretary 
shall establish procedures to ensure that the Disability Determination 
Service and Protection and Advocacy System for a State, advocacy 
counselors for eligible beneficiaries, and any other entities that 
provide services to active enrollees and eligible beneficiaries under 
the CLASS program comply with the following:
            ``(1) If the entity provides counseling or planning 
        services, such services are provided in a manner that fosters 
        the best interests of the active enrollee or beneficiary.
            ``(2) The entity has established operating procedures that 
        are designed to avoid or minimize conflicts of interest between 
        the entity and an active enrollee or beneficiary.
            ``(3) The entity provides information about all services 
        and options available to the active enrollee or beneficiary, to 
        the best of its knowledge, including services available through 
        other entities or providers.
            ``(4) The entity assists the active enrollee or beneficiary 
        to access desired services, regardless of the provider.
            ``(5) The entity reports the number of active enrollees and 
        beneficiaries provided with assistance by age, disability, and 
        whether such enrollees and beneficiaries received services from 
        the entity or another entity.
            ``(6) If the entity provides counseling or planning 
        services, the entity ensures that an active enrollee or 
        beneficiary is informed of any financial interest that the 
        entity has in a service provider.
            ``(7) The entity provides an active enrollee or beneficiary 
        with a list of available service providers that can meet the 
        needs of the active enrollee or beneficiary.
The Secretary shall establish the procedures under this subsection that 
apply to the Disability Determination Service in coordination with the 
Commissioner of Social Security.

``SEC. 3206. CLASS INDEPENDENCE FUND.

    ``(a) Establishment of CLASS Independence Fund.--There is 
established in the Treasury of the United States a trust fund to be 
known as the `CLASS Independence Fund'. The Secretary of the Treasury 
shall serve as Managing Trustee of such Fund. The Fund shall consist of 
all amounts derived from payments into the Fund under sections 3204(f) 
and 3205(c)(5)(C)(ii), and remaining after investment of such amounts 
under subsection (b), including additional amounts derived as income 
from such investments. The amounts held in the Fund are appropriated 
and shall remain available without fiscal year limitation--
            ``(1) to be held for investment on behalf of individuals 
        enrolled in the CLASS program;
            ``(2) to pay the administrative expenses related to the 
        Fund and to investment under subsection (b); and
            ``(3) to pay cash benefits to eligible beneficiaries under 
        the CLASS Independence Benefit Plan.
    ``(b) Investment of Fund Balance.--The Secretary of the Treasury 
shall invest and manage the CLASS Independence Fund in the same manner, 
and to the same extent, as the Federal Supplementary Medical Insurance 
Trust Fund may be invested and managed under subsections (c), (d), and 
(e) of section 1841(d) of the Social Security Act (42 U.S.C. 1395t).
    ``(c) Lock-Box Protection.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, it shall not be in order in the Senate or the House of 
        Representatives to consider any measure that would authorize 
        the payment or use of amounts in the Fund for any purpose other 
        than a purpose authorized under this title.
            ``(2) 60-vote waiver required in the senate.--
                    ``(A) In general.--Paragraph (1) may be waived or 
                suspended in the Senate only by the affirmative vote of 
                \3/5\ of the Members, duly chosen and sworn.
                    ``(B) Appeals.--
                            ``(i) Procedure.--Appeals in the Senate 
                        from the decisions of the Chair relating to 
                        subparagraph (A) shall be limited to 1 hour, to 
                        be equally divided between, and controlled by, 
                        the mover and the manager of the measure that 
                        would authorize the payment or use of amounts 
                        in the Fund for a purpose other than a purpose 
                        authorized under this title.
                            ``(ii) 60-votes required.--An affirmative 
                        vote of \3/5\ of the Members, duly chosen and 
                        sworn, shall be required in the Senate to 
                        sustain an appeal of the ruling of the Chair on 
                        a point of order raised in relation to 
                        subparagraph (A).
            ``(3) Rules of the senate and house of representatives.--
        This subsection is enacted by Congress--
                    ``(A) as an exercise of the rulemaking power of the 
                Senate and House of Representatives, respectively, and 
                is deemed to be part of the rules of each House, 
                respectively, but applicable only with respect to the 
                procedure to be followed in that House in the case of a 
                measure described in paragraph (1), and it supersedes 
                other rules only to the extent that it is inconsistent 
                with such rules; and
                    ``(B) with full recognition of the constitutional 
                right of either House to change the rules (so far as 
                they relate to the procedure of that House) at any 
                time, in the same manner, and to the same extent as in 
                the case of any other rule of that House.
    ``(d) Board of Trustees.--
            ``(1) In general.--With respect to the CLASS Independence 
        Fund, there is hereby created a body to be known as the Board 
        of Trustees of the CLASS Independence Fund (hereinafter in this 
        section referred to as the `Board of Trustees') composed of the 
        Commissioner of Social Security, the Secretary of the Treasury, 
        the Secretary of Labor, and the Secretary of Health and Human 
        Services, all ex officio, and of two members of the public 
        (both of whom may not be from the same political party), who 
        shall be nominated by the President for a term of 4 years and 
        subject to confirmation by the Senate. A member of the Board of 
        Trustees serving as a member of the public and nominated and 
        confirmed to fill a vacancy occurring during a term shall be 
        nominated and confirmed only for the remainder of such term. An 
        individual nominated and confirmed as a member of the public 
        may serve in such position after the expiration of such 
        member's term until the earlier of the time at which the 
        member's successor takes office or the time at which a report 
        of the Board is first issued under paragraph (2) after the 
        expiration of the member's term. The Secretary of the Treasury 
        shall be the Managing Trustee of the Board of Trustees. The 
        Board of Trustees shall meet not less frequently than once each 
        calendar year. A person serving on the Board of Trustees shall 
        not be considered to be a fiduciary and shall not be personally 
        liable for actions taken in such capacity with respect to the 
        Trust Fund.
            ``(2) Duties.--
                    ``(A) In general.--It shall be the duty of the 
                Board of Trustees to do the following:
                            ``(i) Hold the CLASS Independence Fund.
                            ``(ii) Report to the Congress not later 
                        than the first day of April of each year on the 
                        operation and status of the CLASS Independence 
                        Fund during the preceding fiscal year and on 
                        its expected operation and status during the 
                        current fiscal year and the next 2 fiscal 
                        years.
                            ``(iii) Report immediately to the Congress 
                        whenever the Board is of the opinion that the 
                        amount of the CLASS Independence Fund is not 
                        actuarially sound in regards to the projections 
                        under section 3203(b)(2)(B)(i).
                            ``(iv) Review the general policies followed 
                        in managing the CLASS Independence Fund, and 
                        recommend changes in such policies, including 
                        necessary changes in the provisions of law 
                        which govern the way in which the CLASS 
                        Independence Fund is to be managed.
                    ``(B) Report.--The report provided for in 
                subparagraph (A)(ii) shall--
                            ``(i) include--
                                    ``(I) a statement of the assets of, 
                                and the disbursements made from, the 
                                CLASS Independence Fund during the 
                                preceding fiscal year;
                                    ``(II) an estimate of the expected 
                                income to, and disbursements to be made 
                                from, the CLASS Independence Fund 
                                during the current fiscal year and each 
                                of the next 2 fiscal years;
                                    ``(III) a statement of the 
                                actuarial status of the CLASS 
                                Independence Fund for the current 
                                fiscal year, each of the next 2 fiscal 
                                years, and as projected over the 75-
                                year period beginning with the current 
                                fiscal year;
                                    ``(IV) an actuarial opinion by the 
                                Chief Actuary of the Social Security 
                                Administration certifying that the 
                                techniques and methodologies used are 
                                generally accepted within the actuarial 
                                profession and that the assumptions and 
                                cost estimates used are reasonable; and
                                    ``(V) an opinion by the 
                                Commissioner of Social Security that 
                                the Disability Determination Service 
                                personnel are not over burdened by the 
                                additional requirements of the CLASS 
                                program; and
                            ``(ii) be printed as a House document of 
                        the session of the Congress to which the report 
                        is made.
                    ``(C) Recommendations.--If the Board of Trustees 
                determines that enrollment trends and expected future 
                benefit claims on the CLASS Independence Fund are not 
                actuarially sound in regards to the projections under 
                section 3203(b)(2)(B)(i) and are unlikely to be 
                resolved with reasonable premium increases or through 
                other means, the Board of Trustees shall include in the 
                report provided for in subparagraph (A)(ii) 
                recommendations for such legislative action as the 
                Board of Trustees determine to be appropriate, 
                including whether to adjust monthly premiums or impose 
                a temporary moratorium on new enrollments.

``SEC. 3207. CLASS INDEPENDENCE ADVISORY COUNCIL.

    ``(a) Establishment.--There is hereby created an Advisory Committee 
to be known as the `CLASS Independence Advisory Council'.
    ``(b) Membership.--
            ``(1) In general.--The CLASS Independence Advisory Council 
        shall be composed of not more than 15 individuals, not 
        otherwise in the employ of the United States--
                    ``(A) who shall be appointed by the President 
                without regard to the civil service laws and 
                regulations; and
                    ``(B) a majority of whom shall be representatives 
                of individuals who participate or are likely to 
                participate in the CLASS program, and shall include 
                representatives of older and younger workers, 
                individuals with disabilities, family caregivers of 
                individuals who require services and supports to 
                maintain their independence at home or in another 
                residential setting of their choice in the community, 
                individuals with expertise in long-term care or 
                disability insurance, actuarial science, economics, and 
                other relevant disciplines, as determined by the 
                Secretary.
            ``(2) Terms.--
                    ``(A) In general.--The members of the CLASS 
                Independence Advisory Council shall serve overlapping 
                terms of 3 years (unless appointed to fill a vacancy 
                occurring prior to the expiration of a term, in which 
                case the individual shall serve for the remainder of 
                the term).
                    ``(B) Limitation.--A member shall not be eligible 
                to serve for more than 2 consecutive terms.
            ``(3) Chair.--The President shall, from time to time, 
        appoint one of the members of the CLASS Independence Advisory 
        Council to serve as the Chair.
    ``(c) Duties.--The CLASS Independence Advisory Council shall advise 
the Secretary on matters of general policy in the administration of the 
CLASS program established under this title and in the formulation of 
regulations under this title including with respect to--
            ``(1) the development of the CLASS Independence Benefit 
        Plan under section 3203; and
            ``(2) the determination of monthly premiums under such 
        plan.
    ``(d) Application of FACA.--The Federal Advisory Committee Act (5 
U.S.C. App.), other than section 14 of that Act, shall apply to the 
CLASS Independence Advisory Council.
    ``(e) Authorization of Appropriations.--
            ``(1) In general.--There are authorized to be appropriated 
        to the CLASS Independence Advisory Council to carry out its 
        duties under this section, such sums as may be necessary for 
        fiscal year 2011 and for each fiscal year thereafter.
            ``(2) Availability.--Any sums appropriated under the 
        authorization contained in this section shall remain available, 
        without fiscal year limitation, until expended.

``SEC. 3208. REGULATIONS; ANNUAL REPORT.

    ``(a) Regulations.--The Secretary shall promulgate such regulations 
as are necessary to carry out the CLASS program in accordance with this 
title. Such regulations shall include provisions to prevent fraud and 
abuse under the program.
    ``(b) Annual Report.--Beginning January 1, 2014, the Secretary 
shall submit an annual report to Congress on the CLASS program. Each 
report shall include the following:
            ``(1) The total number of enrollees in the program.
            ``(2) The total number of eligible beneficiaries during the 
        fiscal year.
            ``(3) The total amount of cash benefits provided during the 
        fiscal year.
            ``(4) A description of instances of fraud or abuse 
        identified during the fiscal year.
            ``(5) Recommendations for such administrative or 
        legislative action as the Secretary determines is necessary to 
        improve the program or to prevent the occurrence of fraud or 
        abuse.

``SEC. 3209. INSPECTOR GENERAL'S REPORT.

    ``The Inspector General of the Department of Health and Human 
Services shall submit an annual report to the Secretary and Congress 
relating to the overall progress of the CLASS program and of the 
existence of waste, fraud, and abuse in the CLASS program. Each such 
report shall include findings in the following areas:
            ``(1) The eligibility determination process.
            ``(2) The provision of cash benefits.
            ``(3) Quality assurance and protection against waste, 
        fraud, and abuse.
            ``(4) Recouping of unpaid and accrued benefits.

``SEC. 3210. TAX TREATMENT OF PROGRAM.

    ``The CLASS program shall be treated for purposes of the Internal 
Revenue Code of 1986 in the same manner as a qualified long-term care 
insurance contract for qualified long-term care services.''.
            (2) Conforming amendments to medicaid.--Section 1902(a) of 
        the Social Security Act (42 U.S.C. 1396a(a)), as amended by 
        section 5006(e)(2)(A) of division B of Public Law 111-5, is 
        amended--
                    (A) in paragraph (72), by striking ``and'' at the 
                end;
                    (B) in paragraph (73)(B), by striking the period 
                and inserting ``; and''; and
                    (C) by inserting after paragraph (73) the 
                following:
            ``(74) provide that the State will comply with such 
        regulations regarding the application of primary and secondary 
        payor rules with respect to individuals who are eligible for 
        medical assistance under this title and are eligible 
        beneficiaries under the CLASS program established under title 
        XXXII of the Public Health Service Act as the Secretary shall 
        establish.''.
    (b) Assurance of Adequate Infrastructure for the Provision of 
Personal Care Attendant Workers.--Section 1902(a) of the Social 
Security Act (42 U.S.C. 1396a(a)), as amended by subsection (a)(2), is 
amended--
            (1) in paragraph (73)(B), by striking ``and'' at the end;
            (2) in paragraph (74), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (74), the following:
            ``(75) provide that, not later than 2 years after the date 
        of enactment of the Community Living Assistance Services and 
        Supports Act, each State shall--
                    ``(A) assess the extent to which entities such as 
                providers of home care, home health services, home and 
                community service providers, public authorities created 
                to provide personal care services to individuals 
                eligible for medical assistance under the State plan, 
                and nonprofit organizations, are serving or have the 
                capacity to serve as fiscal agents for, employers of, 
                and providers of employment-related benefits for, 
                personal care attendant workers who provide personal 
                care services to individuals receiving benefits under 
                the CLASS program established under title XXXII of the 
                Public Health Service Act, including in rural and 
                underserved areas;
                    ``(B) designate or create such entities to serve as 
                fiscal agents for, employers of, and providers of 
                employment-related benefits for, such workers to ensure 
                an adequate supply of the workers for individuals 
                receiving benefits under the CLASS program, including 
                in rural and underserved areas; and
                    ``(C) ensure that the designation or creation of 
                such entities will not negatively alter or impede 
                existing programs, models, methods, or administration 
                of service delivery that provide for consumer 
                controlled or self-directed home and community services 
                and further ensure that such entities will not impede 
                the ability of individuals to direct and control their 
                home and community services, including the ability to 
                select, manage, dismiss, co-employ, or employ such 
                workers or inhibit such individuals from relying on 
                family members for the provision of personal care 
                services.''.
    (c) Personal Care Attendants Workforce Advisory Panel.--
            (1) Establishment.--Not later than 90 days after the date 
        of enactment of this Act, the Secretary of Health and Human 
        Services shall establish a Personal Care Attendants Workforce 
        Advisory Panel for the purpose of examining and advising the 
        Secretary and Congress on workforce issues related to personal 
        care attendant workers, including with respect to the adequacy 
        of the number of such workers, the salaries, wages, and 
        benefits of such workers, and access to the services provided 
        by such workers.
            (2) Membership.--In appointing members to the Personal Care 
        Attendants Workforce Advisory Panel, the Secretary shall ensure 
        that such members include the following:
                    (A) Individuals with disabilities of all ages.
                    (B) Senior individuals.
                    (C) Representatives of individuals with 
                disabilities.
                    (D) Representatives of senior individuals.
                    (E) Representatives of workforce and labor 
                organizations.
                    (F) Representatives of home and community-based 
                service providers.
                    (G) Representatives of assisted living providers.
    (d) Inclusion of Information on Supplemental Coverage in the 
National Clearinghouse for Long-term Care Information; Extension of 
Funding.--Section 6021(d) of the Deficit Reduction Act of 2005 (42 
U.S.C. 1396p note) is amended--
            (1) in paragraph (2)(A)--
                    (A) in clause (ii), by striking ``and'' at the end;
                    (B) in clause (iii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following:
                            ``(iv) include information regarding the 
                        CLASS program established under title XXXII of 
                        the Public Health Service Act and coverage 
                        available for purchase through a Gateway 
                        established under section 3101 of such Act that 
                        is supplemental coverage to the benefits 
                        provided under a CLASS Independence Benefit 
                        Plan under that program.''; and
            (2) in paragraph (3), by striking ``2010'' and inserting 
        ``2015''.
    (e) Effective Date.--The amendments made by subsections (a), (b), 
and (d) take effect on January 1, 2011.

     TITLE II--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE

      Subtitle A--National Strategy to Improve Health Care Quality

SEC. 201. NATIONAL STRATEGY.

    (a) In General.--Title III of the Public Health Service Act (42 
U.S.C. 241 et seq.) is amended by adding at the end the following:

                 ``PART S--HEALTH CARE QUALITY PROGRAMS

 ``Subpart I--National Strategy for Quality Improvement in Health Care

``SEC. 399HH. NATIONAL STRATEGY FOR QUALITY IMPROVEMENT IN HEALTH CARE.

    ``(a) Establishment of National Strategy and Priorities.--
            ``(1) National strategy.--The Secretary, through a 
        transparent collaborative process, shall establish a national 
        strategy to improve the delivery of health care services, 
        patient health outcomes, and population health.
            ``(2) Identification of priorities.--
                    ``(A) In general.--The Secretary shall identify 
                national priorities for improvement in developing the 
                strategy under paragraph (1).
                    ``(B) Requirements.--The Secretary shall ensure 
                that priorities identified under subparagraph (A) 
                will--
                            ``(i) address the health care provided to 
                        patients with high-cost chronic diseases;
                            ``(ii) improve the design, development, 
                        demonstration, dissemination, and adoption of 
                        infrastructure and innovative methodologies and 
                        strategies for quality improvement in the 
                        delivery of health care services that represent 
                        best practices to improve patient safety and 
                        reduce medical errors, preventable admissions 
                        and readmissions, and health care-associated 
                        infections;
                            ``(iii) have the greatest potential for 
                        improving the health outcomes, efficiency, and 
                        patient-centeredness of health care;
                            ``(iv) reduce health disparities across 
                        health disparity populations (as defined by 
                        section 485E) and geographic areas;
                            ``(v) address gaps in quality and health 
                        outcomes measures, comparative effectiveness 
                        information, and data aggregation techniques, 
                        including the use of data registries;
                            ``(vi) identify areas in the delivery of 
                        health care services that have the potential 
                        for rapid improvement in the quality of patient 
                        care;
                            ``(vii) improve Federal payment policy to 
                        emphasize quality;
                            ``(viii) enhance the use of health care 
                        data to improve quality, transparency, and 
                        outcomes; and
                            ``(ix) address other areas as determined 
                        appropriate by the Secretary.
                    ``(C) Considerations.--In identifying priorities 
                under subparagraph (A), the Secretary shall take into 
                consideration--
                            ``(i) the recommendations submitted by 
                        qualified consensus-based entities as required 
                        under section 399JJ; and
                            ``(ii) the recommendations of the 
                        Interagency Working Group on Health Care 
                        Quality established under section 202 of the 
                        Affordable Health Choices Act.
    ``(b) Strategic Plan.--
            ``(1) In general.--The national strategy shall include a 
        comprehensive strategic plan to achieve the priorities 
        described in subsection (a).
            ``(2) Requirements.--The strategic plan shall include 
        provisions for addressing, at a minimum, the following:
                    ``(A) Coordination among agencies within the 
                Department, which shall include steps to minimize 
                duplication of efforts and utilization of common 
                quality measures, where available. Such common quality 
                measures shall be measures endorsed under section 
                399JJ.
                    ``(B) Agency-specific strategic plans to achieve 
                national priorities.
                    ``(C) Establishment of annual benchmarks for each 
                relevant agency to achieve national priorities.
                    ``(D) A process for regular reporting by the 
                agencies to the Secretary on the implementation of the 
                strategic plan.
                    ``(E) Use of common incentives among public and 
                private payers with regard to quality and patient 
                safety efforts.
                    ``(F) Incorporating quality improvement and 
                measurement in the strategic plan for health 
                information technology required by the American 
                Recovery and Reinvestment Act of 2009 (Public Law 111-
                5).
    ``(c) Periodic Update of National Strategy.--The Secretary shall 
update the national strategy not less than triennially. Any such update 
shall include a review of short- and long-term goals.
    ``(d) Submission and Availability of National Strategy.--The 
Secretary shall transmit to the relevant Committees of Congress the 
national strategy and updates to such strategy.
    ``(e) Public Reporting.--
            ``(1) Annual national health care quality report card.--Not 
        later than January 31, 2011, and annually thereafter, the 
        Secretary shall publish a national health care quality report 
        card, which shall include--
                    ``(A) the considerations for national priorities 
                described in subsection (a)(2);
                    ``(B) an analysis of the progress of the strategic 
                plans under subsection (b)(2)(B) in achieving the 
                national priorities under subsection (a)(2), and any 
                gaps in such strategic plans;
                    ``(C) the extent to which private sector strategies 
                have informed Federal quality improvement efforts; and
                    ``(D) a summary of consumer and provider feedback 
                regarding quality improvement practices.
            ``(2) Website.--Not later than July 1, 2010, the Director 
        shall create an Internet website to make public information 
        regarding--
                    ``(A) the national priorities for health care 
                quality improvement established under subsection 
                (a)(2);
                    ``(B) the agency-specific strategic plans for 
                health care quality described in subsection (b)(2)(B);
                    ``(C) the annual national health care quality 
                report card described in paragraph (1); and
                    ``(D) other information, as the Secretary 
                determines to be appropriate.''.
    (b) Agency Quality Review.--
            (1) In general.--Each relevant agency within the Department 
        of Health and Human Services shall review the statutory 
        authority, regulations, policies, and procedures of such 
        agency, as in effect on the date of enactment of this title, 
        for purposes of determining whether there are any deficiencies 
        or inconsistencies that prohibit full compliance with the 
        intent, purposes, and provisions of this title (and the 
        amendments made by this title).
            (2) Proposals.--Each agency described in paragraph (1) 
        shall, not later than July 1, 2010, submit to the Secretary of 
        Health and Human Services a proposal of the measures as may be 
        necessary to bring the authority, regulations, policies, and 
        procedures of such agency into conformity with the intent, 
        purposes, and provisions of the this title (and the amendments 
        made by this title).

SEC. 202. INTERAGENCY WORKING GROUP ON HEALTH CARE QUALITY.

    (a) In General.--The President shall convene a working group to be 
known as the Interagency Working Group on Health Care Quality (referred 
to in this section as the ``Working Group'').
    (b) Goals.--The goals of the Working Group shall be to achieve the 
following:
            (1) Collaboration, cooperation, and consultation between 
        Federal departments and agencies with respect to developing and 
        disseminating strategies, goals, models, and timetables that 
        are consistent with the national priorities identified under 
        section 399HH(a)(2) of the Public Health Service Act (as added 
        by section 201).
            (2) Avoidance of inefficient duplication of quality 
        improvement efforts and resources, where practicable, and a 
        streamlined process for quality reporting and compliance 
        requirements.
    (c) Composition.--
            (1) In general.--The Working Group shall be composed of 
        senior level representatives of--
                    (A) the Department of Health and Human Services;
                    (B) the Department of Labor;
                    (C) the United States Office of Personnel 
                Management;
                    (D) the Department of Defense;
                    (E) the Department of Education;
                    (F) the Department of Veterans Affairs; and
                    (G) any other Federal agencies and departments with 
                activities relating to improving health care quality 
                and safety, as determined by the President.
            (2) Chair and vice-chair.--
                    (A) Chair.--The Working Group shall be chaired by 
                the Secretary of Health and Human Services.
                    (B) Vice-chair.--Members of the Working Group, 
                other than the Secretary of Health and Human Services, 
                shall serve as Vice Chair of the Group on a rotating 
                basis, as determined by the Group.
    (d) Report to Congress.--Not later than December 31, 2010, and 
annually thereafter, the Working Group shall submit to the relevant 
Committees of Congress, and make public on an Internet website, a 
report describing the progress and recommendations of the Working Group 
in meeting the goals described in subsection (b).

SEC. 203. QUALITY MEASURE DEVELOPMENT.

    Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) 
is amended--
            (1) by redesignating part D as part E;
            (2) by redesignating sections 931 through 938 as sections 
        941 through 948, respectively;
            (3) in section 948(1), as so redesignated, by striking 
        ``931'' and inserting ``941''; and
            (4) by inserting after section 926 the following:

               ``PART D--HEALTH CARE QUALITY IMPROVEMENT

                ``Subpart I--Quality Measure Development

``SEC. 931. QUALITY MEASURE DEVELOPMENT.

    ``(a) Quality Measure.--In this subpart, the term `quality measure' 
means a standard for measuring the performance and improvement of 
population health or of health plans, providers of services, and other 
clinicians in the delivery of health care services.
    ``(b) Identification of Quality Measures.--
            ``(1) Identification.--The Director shall identify, not 
        less often than biennially, gaps where no quality measures 
        exist, or where existing quality measures need improvement, 
        updating, or expansion, consistent with the national strategy 
        under section 399HH, for use in programs authorized under this 
        Act. In identifying such gaps, the Director shall take into 
        consideration the gaps identified by a qualified consensus-
        based entity under section 399JJ.
            ``(2) Publication.--The Director shall make available to 
        the public on an Internet website a report on any gaps 
        identified under paragraph (1) and the process used to make 
        such identification.
    ``(c) Grants or Contracts for Quality Measure Development.--
            ``(1) In general.--The Director shall award grants, 
        contracts, or intergovernmental agreements to eligible entities 
        for purposes of developing, improving, updating, or expanding 
        quality measures identified under subsection (b).
            ``(2) Prioritization in the development of quality 
        measures.--In awarding grants, contracts, or agreements under 
        this subsection, the Director shall give priority to the 
        development of quality measures that allow the assessment of--
                    ``(A) health outcomes and functional status of 
                patients;
                    ``(B) the continuity, management, and coordination 
                of health care and care transitions, including episodes 
                of care, for patients across the continuum of 
                providers, health care settings, and health plans;
                    ``(C) patient, caregiver, and authorized 
                representative experience, quality and relevance of 
                information provided to patients, caregivers, and 
                authorized representatives, and use of information by 
                patients, caregivers, and authorized representatives to 
                inform decisionmaking about treatment options and, 
                where appropriate, palliative care;
                    ``(D) the safety, effectiveness, and timeliness of 
                care;
                    ``(E) health disparities across health disparity 
                populations (as defined in section 485E) and geographic 
                areas;
                    ``(F) the appropriate use of health care resources 
                and services; or
                    ``(G) use of innovative strategies and 
                methodologies identified under section 933.
            ``(3) Eligible entities.--To be eligible for a grant or 
        contract under this subsection, an entity shall--
                    ``(A) have demonstrated expertise and capacity in 
                the development and evaluation of quality measures;
                    ``(B) have adopted procedures to include in the 
                quality measure development process--
                            ``(i) the views of those providers or 
                        payers whose performance will be assessed by 
                        the measure; and
                            ``(ii) the views of other parties who also 
                        will use the quality measures (such as 
                        patients, consumers, and health care 
                        purchasers);
                    ``(C) collaborate with a qualified consensus-based 
                entity (as defined in section 399JJ), as practicable, 
                and the Secretary so that quality measures developed by 
                the eligible entity will meet the requirements to be 
                considered for endorsement by such qualified consensus-
                based entity;
                    ``(D) have transparent policies regarding conflicts 
                of interest; and
                    ``(E) submit an application to the Director at such 
                time and in such manner, as the Director may require.
            ``(4) Use of funds.--An entity that receives a grant, 
        contract, or agreement under this subsection shall use such 
        award to develop quality measures that meet the following 
        requirements:
                    ``(A) Such measures build upon measures developed 
                under section 1139A of Social Security Act, where 
                applicable.
                    ``(B) To the extent practicable, data on such 
                quality measures is able to be collected using health 
                information technologies.
                    ``(C) Each quality measure is free of charge to 
                users of such measure.
                    ``(D) Each quality measure is publicly available on 
                an Internet website.
    ``(d) Other Activities by the Director.--The Director may use 
amounts available under this section to update and test, where 
applicable, quality measures endorsed by a qualified consensus-based 
entity (as defined in section 399JJ) or adopted by the Secretary.
    ``(e) Funding.--There are authorized to be appropriated to carry 
out this section, $75,000,000 for each of fiscal years 2010 through 
2014.''.

SEC. 204. QUALITY MEASURE ENDORSEMENT; PUBLIC REPORTING; DATA 
              COLLECTION.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), 
as amended by section 201, is further amended by adding at the end the 
following:

               ``Subpart II--Health Care Quality Programs

``SEC. 399JJ. QUALITY MEASURE ENDORSEMENT.

    ``(a) Definitions.--In this subpart:
            ``(1) Qualified consensus-based entity.--The term 
        `qualified consensus-based entity' means an entity with a 
        contract with the Secretary under section 1890 of the Social 
        Security Act.
            ``(2) Quality measure.--The term `quality measure' means a 
        standard for measuring the performance and improvement of 
        population health or of health plans, providers of services, 
        and other clinicians in the delivery of health care services.
            ``(3) Multi-stakeholder group.--The term `multi-stakeholder 
        group' means, with respect to a quality measure, a voluntary 
        collaborative of organizations representing a broad group of 
        stakeholders interested in or affected by the use of such 
        quality measure.
    ``(b) Grants and Contracts.--A qualified consensus-based entity may 
receive a grant or contract under this subsection to--
            ``(1) make recommendations to the Secretary for national 
        priorities for performance improvement in population health and 
        in the delivery of health care services;
            ``(2) identify gaps in endorsed quality measures, which 
        shall include measures that--
                    ``(A) are within priority areas identified by the 
                Secretary under the national strategy established under 
                section 399HH;
                    ``(B) assess common care episodes, patient health 
                outcomes, processes, efficiency, cost, and appropriate 
                use of health care services and resources and address 
                health disparities across health disparity populations 
                (as defined in section 485E) and geographic areas; or
                    ``(C) assess use of innovative methodologies and 
                strategies for quality improvement practices in the 
                delivery of health care services that represent best 
                practices for such quality improvement identified in 
                section 933;
            ``(3) identify and endorse quality measures, including 
        measures that address gaps identified in paragraph (2);
            ``(4) update endorsed quality measures at least every 3 
        years;
            ``(5) make endorsed quality measures publicly available and 
        have a plan for broad-based dissemination of endorsed measures; 
        and
            ``(6) transmit endorsed quality measures to the Secretary.
    ``(c) Annual Reports.--
            ``(1) In general.--A qualified consensus-based entity that 
        receives a grant or contract under this section shall provide a 
        report to the Secretary not less than annually--
                    ``(A) of where gaps (as described in subsection 
                (b)(2)) exist and where quality measures are 
                unavailable or inadequate to identify or address such 
                gaps; and
                    ``(B) regarding areas in which evidence is 
                insufficient to support endorsement of quality measures 
                in priority areas identified by the Secretary under the 
                national strategy established under section 399HH and 
                where targeted research may address such gaps.
            ``(2) Impact of quality measures.--A qualified consensus-
        based entity that receives a grant or contract under this 
        section shall provide a report to the Secretary not less than 
        annually regarding the economic and quality impact of the use 
        of endorsed measures.
    ``(d) Priorities for Performance Improvement.--
            ``(1) Recommendation for national priorities.--A qualified 
        consensus-based entity that receives a grant or contract under 
        this section shall evaluate evidence and convene multi-
        stakeholder groups to make recommendations to the Secretary for 
        national priorities for performance improvement in population 
        health and in the delivery of health care services for 
        consideration under the national strategy established under 
        section 399HH. The qualified consensus-based entity shall make 
        such recommendations not less frequently than triennially.
            ``(2) Requirements for transparency in process.--
                    ``(A) In general.--In convening multi-stakeholder 
                groups under paragraph (1) with respect to 
                recommendations for national priorities, the qualified 
                consensus-based entity shall provide for an open and 
                transparent process for the activities conducted 
                pursuant to such convening.
                    ``(B) Selection of organizations participating in 
                multi-stakeholder groups.--The process under 
                subparagraph (A) shall ensure that the selection of 
                representatives comprising such groups provides for 
                public nominations for, and the opportunity for public 
                comment on, such selection.
            ``(3) Considerations in recommending priorities.--In making 
        recommendations under paragraph (1), the qualified consensus-
        based entity shall ensure that priority is given to areas in 
        the delivery of health care services for all populations 
        including children, and other vulnerable populations that--
                    ``(A) address the health care provided to patients 
                with prevalent, high-cost chronic diseases;
                    ``(B) improve the design, development, 
                demonstration, and adoption of infrastructure and 
                innovative methodologies and strategies for quality 
                improvement practices in the delivery of health care 
                services, including those that improve patient safety 
                and reduce medical errors, readmissions, and health 
                care-associated infections;
                    ``(C) have the greatest potential for improving the 
                health outcomes, efficiency, and patient-centeredness 
                of health care;
                    ``(D) reduce health disparities across populations 
                (as defined in section 485E) and geographic areas;
                    ``(E) address gaps in quality and health outcomes 
                measures, comparative effectiveness information, and 
                data aggregation techniques, including the use of data 
                registries;
                    ``(F) identify areas in the delivery of health care 
                services that have the potential for rapid improvement 
                in the quality of patient care; and
                    ``(G) address the appropriate use of health care 
                technology, resources and services.
    ``(e) Process for Consultation of Stakeholder Groups.--
            ``(1) Consultation of selection of endorsed quality 
        measures.--A qualified consensus-based entity that receives a 
        grant or contract under this section shall convene multi-
        stakeholder groups to provide guidance on the selection of 
        individual or composite quality measures, for use in reporting 
        performance information to the public or for use in Federal 
        health programs, from among--
                    ``(A) such measures that have been endorsed by the 
                qualified consensus-based entity (under section 1890(b) 
                of the Social Security Act or otherwise); and
                    ``(B) such measures that have not been considered 
                for endorsement by the qualified consensus-based entity 
                but are used or proposed to be used by the Secretary 
                under subsection (f)(2) under laws under the 
                jurisdiction of the Secretary that require the 
                collection or reporting of quality measures.
            ``(2) Transmission of multi-stakeholder guidance.--The 
        qualified consensus-based entity shall transmit to the 
        Secretary the guidance of multi-stakeholder groups provided 
        under paragraph (1).
            ``(3) Requirement for transparency in process.--
                    ``(A) In general.--In convening multi-stakeholder 
                groups under paragraph (1) with respect to the 
                selection of quality measures, the qualified consensus-
                based entity shall provide for an open and transparent 
                process for the activities conducted pursuant to such 
                convening.
                    ``(B) Selection of organizations participating in 
                multi-stakeholder groups.--The process under 
                subparagraph (A) shall ensure that the selection of 
                representatives comprising such groups provides for 
                public nominations for, and the opportunity for public 
                comment on, such selection.
    ``(f) Coordination of Use of Quality Measures.--
            ``(1) Endorsed quality measures.--The Secretary may make a 
        determination under regulation or otherwise to use a quality 
        measure described in subsection (e)(1)(A) only after taking 
        into account the guidance of multi-stakeholder groups under 
        subsection (e)(2).
            ``(2) Use of interim measures.--
                    ``(A) In general.--The Secretary may make a 
                determination, by regulation or otherwise, to use a 
                quality measure that has not been endorsed as described 
                in subsection (e)(1)(A), provided that the Secretary--
                            ``(i) in a timely manner, transmits the 
                        measure to the qualified consensus-based entity 
                        for consideration for endorsement and for the 
                        multi-stakeholder consultation process under 
                        subsection (e)(1);
                            ``(ii) publishes in the Federal Register 
                        the rationale for the use of the measure; and
                            ``(iii) phases out use of the measure upon 
                        a decision of the qualified consensus-based 
                        entity not to endorse the measure, contingent 
                        on availability of an adequate alternative 
                        endorsed measure (as determined by the 
                        Secretary), taking into account guidance from 
                        multi-stakeholder consultation process under 
                        subsection (e)(1).
                    ``(B) No adequate alternative.--If an adequate 
                alternative endorsed measure is not available, the 
                Secretary shall support the development of such an 
                alternative endorsed measure, as described in section 
                931.
            ``(3) Requirement of coordination with entity.--
                    ``(A) Requirement for notification of entity of 
                deadline for recommendations for quality measures in 
                proposed regulations.--For each notice of proposed 
                rulemaking to implement the collection or reporting of 
                data on quality measures as described in section 399LL, 
                the Secretary shall establish a process for the regular 
                provision of advance notice to the qualified consensus-
                based entity of the date certain by which 
                recommendations of the entity with respect to quality 
                measures must be submitted to the Secretary for 
                consideration in the development of such specified 
                regulation.
                    ``(B) Timely notice.--Under the process established 
                under subparagraph (A), notice shall be given to the 
                qualified consensus-based entity not less than 120 days 
                before the date certain referred to in subparagraph 
                (A).
                    ``(C) Publication of description of entity 
                recommendations and responses.--In publishing a 
                specified regulation, the Secretary shall include a 
                description of each recommendation of the qualified 
                consensus-based entity with respect to quality measures 
                and shall include responses of the Secretary to each 
                such recommendation.
                    ``(D) Definition.--In this paragraph, the term 
                `specified regulation' means a notice of proposed 
                rulemaking to implement the collection or reporting of 
                data on quality measures as described in section 399LL.
            ``(4) Effective date.--This subsection shall apply with 
        respect to determinations or requirements by the Secretary for 
        the use of quality measures made on or after the date of 
        enactment of the Affordable Health Choices Act.
    ``(g) Review of Quality Measures Used by the Secretary.--
            ``(1) In general.--Not less than once every 3 years, the 
        Secretary shall review quality measures used by the Secretary 
        and, with respect to each such measure, shall determine whether 
        to--
                    ``(A) maintain the use of such measure; or
                    ``(B) phase out such measure.
            ``(2) Considerations.--In conducting the review under 
        paragraph (1), the Secretary shall--
                    ``(A) seek to avoid duplication of measures used; 
                and
                    ``(B) take into consideration current innovative 
                methodologies and strategies for quality improvement 
                practices in the delivery of health care services that 
                represent best practices for such quality improvement 
                and measures endorsed by a qualified consensus-based 
                entity since the previous review by the Secretary.
    ``(h) Process for Dissemination of Measures Used by the 
Secretary.--The Secretary shall establish a process for disseminating 
quality measures used by the Secretary. Such process shall include the 
incorporation of such measures, where applicable, in workforce 
programs, training curricula, payment programs, and any other means of 
dissemination determined by the Secretary. The Secretary shall 
establish a process to disseminate such quality measures through the 
Interagency Working Group established under section 202 of the 
Affordable Health Choices Act.
    ``(i) Funding.--To carry out this section there are authorized to 
be appropriated $50,000,000 for each of fiscal years for 2010 through 
2014.

``SEC. 399KK. PUBLIC REPORTING OF PERFORMANCE INFORMATION.

    ``(a) Reporting of Quality Measures.--
            ``(1) In general.--
                    ``(A) Reporting system.--Not later than 5 years 
                after the date of enactment of the Affordable Health 
                Choices Act, and after notice and opportunity for 
                public comment, the Secretary shall implement a system 
                for the reporting on quality measures that protect 
                patient privacy and, where appropriate--
                            ``(i) assess health outcomes and functional 
                        status of patients;
                            ``(ii) assess the continuity and 
                        coordination of care and care transitions, 
                        including episodes of care, for patients across 
                        the continuum of providers and health care 
                        settings;
                            ``(iii) assess patient experience and 
                        patient, caregiver, and family engagement;
                            ``(iv) assess the safety, effectiveness, 
                        and timeliness of care; and
                            ``(v) assess health disparities (as defined 
                        by section 485E) across populations and 
                        geographic areas.
            ``(2) Form and manner.--The data submitted under the system 
        implemented under paragraph (1) shall be in a form and manner 
        specified by the Secretary.
            ``(3) Measures described.--The quality measures described 
        in paragraph (1) shall--
                    ``(A) be risk adjusted, taking into account 
                differences in patient health status, patient 
                characteristics, and geographic location, as 
                appropriate;
                    ``(B) be valid, reliable, evidence-based, feasible 
                to collect, and actionable by providers, payers and 
                consumers, as appropriate;
                    ``(C) minimize the burden of collection and 
                reporting such measures; and
                    ``(D) be consistent with the national strategy 
                established by the Secretary under section 399HH.
    ``(b) Development of Performance Websites.--The Secretary shall 
make available to the public performance information summarizing data 
on quality measures collected in subsection (a) through a series of 
standardized Internet websites tailored to respond to the differing 
needs of hospitals and other institutional providers and services, 
physicians and other clinicians, patients, consumers, researchers, 
policymakers, States, and such other stakeholders as the Secretary may 
specify.
    ``(c) Design.--Each standardized Internet website made available 
under subsection (b) shall be designed to make the use and navigation 
of that website readily available to individuals accessing it. The 
Secretary shall develop a flexible format to meet the differing needs 
of the various stakeholders and shall modify the website to permit a 
user to easily customize queries.
    ``(d) Information on Conditions.--Performance information made 
publicly available on a standardized Internet website under subsection 
(b) shall be presented by, but not limited to, clinical condition to 
the extent such information is available, and the information presented 
shall, where appropriate, be provider-specific and sufficiently 
disaggregated and specific to meet the needs of patients with different 
clinical conditions.
    ``(e) Consultation.--The Secretary shall carry out this section in 
collaboration with a qualified consensus-based entity under section 
399JJ to determine the type of information that is useful to 
stakeholders and the format that best facilitates use of the reports 
and of performance reporting Internet websites. The qualified 
consensus-based entity shall convene multi-stakeholder groups as 
provided in section 399JJ to review the design and format of each 
Internet website made available under subsection (b) and shall transmit 
to the Secretary the views of such multi-stakeholder groups with 
respect to each such design and format.

``SEC. 399LL. EVALUATION OF DATA COLLECTION PROCESS FOR QUALITY 
              MEASUREMENT.

    ``(a) GAO Evaluations.--The Comptroller General of the United 
States shall conduct periodic evaluations of the implementation of the 
data collection processes for quality measures used by the Secretary.
    ``(b) Considerations.--In carrying out the evaluation under 
subsection (a), the Comptroller General shall determine--
            ``(1) whether the system for the collection of data for 
        quality measures provides for validation of data as relevant, 
        fair, and scientifically credible;
            ``(2) whether data collection efforts under the system use 
        the most efficient and cost-effective means in a manner that 
        minimizes administrative burden on persons required to collect 
        data and that adequately protects the privacy of patients' 
        personal health information and provides data security;
            ``(3) whether standards under the system provide for an 
        opportunity for physicians and other clinicians and 
        institutional providers of services to review and correct 
        findings; and
            ``(4) the extent to which quality measures--
                    ``(A) assess health outcomes and functional status 
                of patients;
                    ``(B) assess the continuity and coordination of 
                care and care transitions, including episodes of care, 
                for patients across the continuum of providers, age, 
                and health care settings;
                    ``(C) assess patient experience and patient, 
                caregiver, and family engagement;
                    ``(D) assess the safety, effectiveness, and 
                timeliness of care;
                    ``(E) assess health disparities across health 
                disparity populations (as defined by section 485E) and 
                geographic areas;
                    ``(F) address the appropriate use of health care 
                resources and services;
                    ``(G) are designed to be collected as part of 
                health information technologies supporting better 
                delivery of health care services;
                    ``(H) result in direct or indirect costs to users 
                of such measures; and
                    ``(I) provide utility to both the care of 
                individuals and the management of population health.
    ``(c) Report.--The Comptroller General shall submit reports to 
Congress and to the Secretary containing a description of the findings 
and conclusions of the results of each such evaluation.''.

SEC. 205. COLLECTION AND ANALYSIS OF DATA FOR QUALITY AND RESOURCE USE 
              MEASURES.

    (a) In General.--Part S of title III of the Public Health Service 
Act, as amended by section 204, is further amended by adding at the end 
the following:

``SEC. 399MM. COLLECTION AND ANALYSIS OF DATA FOR QUALITY AND RESOURCE 
              USE MEASURES.

    ``(a) Purpose.--The purpose of this section is to provide for the 
development of reports based on Federal health care data and private 
data that is publicly available or is provided by the entity making the 
request for the report in order to--
            ``(1) improve the quality and efficiency of health care and 
        advance health care research;
            ``(2) enhance the education and awareness of consumers for 
        evaluating health care services; and
            ``(3) provide the public with reports on national, 
        regional, and provider- and supplier-specific performance, 
        which may be in a provider- or supplier-identifiable format.
    ``(b) Establishment of Process.--The Secretary shall establish a 
process to collect, and validate, aggregate data on quality measures 
described in section 399JJ to facilitate public reporting described in 
section 399KK. Such process shall--
            ``(1) be developed based on guidance of a broad-based, 
        public-private collaboration;
            ``(2) employ methods that are scientifically sound and 
        feasible to implement nationwide through the use of consistent 
        methods for the collection, analysis, and reporting of quality 
        and resource use measures;
            ``(3) over time, where feasible, build on expanding 
        availability of health information technology and other data 
        systems that are directly used to improve and coordinate 
        patient care;
            ``(4) allow for the integration of data on quality of care 
        and resource use from a range of data sources used by providers 
        and patients to coordinate and improve care, including public 
        sources, private sources, and public-private collaborations;
            ``(5) be implemented in accordance with an aggressive 
        timeline to be established by the Secretary based on the 
        technical and practical feasibility of measures and related 
        data systems; and
            ``(6) utilize clinical and claims data to evaluate the 
        quality and efficiency of health care.
    ``(c) Data Collection, Aggregation, and Analysis.--The Secretary 
shall ensure the collection and aggregation of consistent data on 
quality and resource use measures from information systems used to 
support health care delivery to implement the public reporting of 
performance information as described in section 399KK. The Secretary 
shall ensure that such collection, aggregation, and analysis systems 
span an increasingly broad range of patient populations, providers, and 
geographic areas over time.
    ``(d) Grants and Contracts for Data Collection.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts to eligible entities to support the collection and 
        aggregation of quality and resource use measures described 
        under subsection (c).
            ``(2) Eligible entities.--To be eligible for a grant or 
        contract under this subsection, an entity shall--
                    ``(A)(i) be a multi-stakeholder entity that 
                coordinates the development of methods and 
                implementation plans for the consistent reporting of 
                summary quality and cost information;
                    ``(ii) be an entity capable of submitting such 
                summary data for a particular population and providers, 
                such as a disease registry, regional collaboration, 
                health plan collaboration, or other population-wide 
                source; or
                    ``(iii) be a Federal Indian Health Service program 
                or a health program operated by an Indian Tribe (as 
                defined in section 4 of the Indian Health Care 
                Improvement Act);
                    ``(B) promote the use of the systems that provide 
                data to improve and coordinate patient care;
                    ``(C) support the provision of timely, consistent 
                quality and resource use information to health care 
                providers, and other groups and organizations as 
                appropriate, with an opportunity for providers to 
                correct inaccurate measures; and
                    ``(D) support the provision of consistent measures 
                on quality and resource use to the public in accordance 
                with the process established by the Secretary under 
                subsection (b).
            ``(3) Consistent data aggregation.--The Secretary shall 
        award funding under this subsection only to entities enabling 
        summary data that can be integrated and compared across 
        multiple sources. The Secretary shall also provide standards 
        for the protection of the security and privacy of patient data.
    ``(e) Pilot Programs to Develop, Validate, and Improve Methods Used 
to Support the Nationwide Quality Measurement and Reporting Strategy.--
            ``(1) In general.--
                    ``(A) Development, validation, and improvement 
                methods.--The Secretary shall support the development, 
                validation, implementation, and refinement of 
                nationally consistent methods used to support quality 
                measurement and reporting under section 399KK.
                    ``(B) Grants and contracts.--The Secretary may 
                award grants or contracts to eligible quality data 
                entities to carry out subparagraph (A).
            ``(2) Eligible quality data entities.--To be eligible for a 
        grant or contract under this subsection, a quality data entity 
        shall--
                    ``(A) be a public or private organization with 
                expertise and experience in large-scale health care 
                data aggregation, integration, analysis, or reporting; 
                and
                    ``(B) support the implementation of quality 
                measurement and reporting under section 399KK, 
                including the production of data that can be combined 
                and compared with equivalent information from other 
                entities involved in supporting the delivery of care.
    ``(f) Grants and Contracts for Data Analysis.--
            ``(1) Federal health care data.--In this subsection:
                    ``(A) In general.--Subject to subparagraph (B), the 
                term `Federal health care data' means--
                            ``(i) deidentified enrollment data and 
                        deidentified claims data maintained by the 
                        Secretary or entities under programs, 
                        contracts, grants, or memoranda of 
                        understanding administered by the Secretary; 
                        and
                            ``(ii) where feasible, other deidentified 
                        enrollment data and deidentified claims data 
                        maintained by the Federal Government or 
                        entities under contract with the Federal 
                        Government.
                    ``(B) Exception.--The term `Federal health care 
                data' includes data relating to programs administered 
                by the Secretary under the Social Security Act only to 
                the extent that the disclosure of such data is 
                authorized or required under such Act.
            ``(2) Awards.--The Secretary shall award contracts to 
        eligible entities to support the analysis of quality and 
        resource use measures described under subsection (c).
            ``(3) Eligible entities.--
                    ``(A) Qualifications.--The Secretary shall enter 
                into a contract with an entity under paragraph (2) only 
                if the Secretary determines that the entity--
                            ``(i) has the research capability to 
                        conduct and complete reports under this 
                        subsection;
                            ``(ii) has in place--
                                    ``(I) an information technology 
                                infrastructure to support the database 
                                of Federal health care data that is to 
                                be disclosed to the entity; and
                                    ``(II) operational standards to 
                                provide security for such database;
                            ``(iii) has experience with, and expertise 
                        on, the development of reports on health care 
                        quality and efficiency; and
                            ``(iv) has a significant business presence 
                        in the United States.
                    ``(B) Contract requirements.--Each contract with an 
                entity under paragraph (2) shall contain the following 
                requirements:
                            ``(i) Ensuring beneficiary privacy.--
                                    ``(I) HIPAA.--The entity shall meet 
                                the requirements imposed on a covered 
                                entity for purposes of applying part C 
                                of title XI and all regulatory 
                                provisions promulgated thereunder, 
                                including regulations (relating to 
                                privacy) adopted pursuant to the 
                                authority of the Secretary under 
                                section 264(c) of the Health Insurance 
                                Portability and Accountability Act of 
                                1996 (42 U.S.C. 1320d-2 note).
                                    ``(II) Other statutory 
                                protections.--The entity shall be 
                                required to refrain from disclosing 
                                data that could be withheld by the 
                                Secretary under section 552 of title 5, 
                                United States Code, or whose disclosure 
                                by the Secretary would violate section 
                                552a of such title.
                            ``(ii) Proprietary information.--The entity 
                        shall provide assurances that the entity will 
                        not disclose any negotiated price concessions, 
                        such as discounts, direct or indirect 
                        subsidies, rebates, and direct or indirect 
                        remunerations, obtained by health care 
                        providers or suppliers or health care plans, or 
                        any other proprietary cost information.
                            ``(iii) Disclosure.--The entity shall 
                        disclose--
                                    ``(I) any financial, reporting, or 
                                contractual relationship between the 
                                entity and any health care provider or 
                                supplier or health care plan; and
                                    ``(II) if applicable, the fact that 
                                the entity is managed, controlled, or 
                                operated by any health care provider or 
                                supplier or health care plan.
                            ``(iv) Component of another organization.--
                        If the entity is a component of another 
                        organization--
                                    ``(I) the entity shall maintain 
                                Federal health care data and reports 
                                separately from the rest of the 
                                organization and establish appropriate 
                                security measures to maintain the 
                                confidentiality and privacy of the 
                                Federal health care data and reports; 
                                and
                                    ``(II) the entity shall not make an 
                                unauthorized disclosure to the rest of 
                                the organization of Federal health care 
                                data or reports in breach of such 
                                confidentiality and privacy 
                                requirement.
                            ``(v) Termination or nonrenewal.--If a 
                        contract under this subsection is terminated or 
                        not renewed, the following requirements shall 
                        apply:
                                    ``(I) Confidentiality and privacy 
                                protections.--The entity shall continue 
                                to comply with the confidentiality and 
                                privacy requirements under this 
                                subsection with respect to all Federal 
                                health care data disclosed to the 
                                entity and each report developed by the 
                                entity.
                                    ``(II) Disposition of data and 
                                reports.--The entity shall--
                                            ``(aa) return to the 
                                        Secretary all Federal health 
                                        care data disclosed to the 
                                        entity and each report 
                                        developed by the entity; or
                                            ``(bb) if returning the 
                                        Federal health care data and 
                                        reports is not practicable, 
                                        destroy the reports and Federal 
                                        health care data.
                            ``(vi) Risk adjustment.--The entity shall 
                        ensure that the methodology used to develop a 
                        report under paragraph (4) shall include 
                        acceptable risk adjustment and case-mix 
                        adjustment developed in consultation with 
                        providers.
                    ``(C) Competitive procedures.--Competitive 
                procedures (as defined in section 4(5) of the Federal 
                Procurement Policy Act) shall be used to enter into 
                contracts under paragraph (2).
                    ``(D) Review of contract in event of a merger or 
                acquisition.--The Secretary shall review the contract 
                with an entity receiving a contract under this 
                subsection in the event of a merger or acquisition of 
                the entity in order to ensure that the requirements 
                under this subsection will continue to be met.
            ``(4) Procedures for the development of reports.--
        Notwithstanding section 552(b)(6) or 552a(b) of title 5, United 
        States Code, subject to paragraph (1)(B), not later than 12 
        months after the date of enactment of this section, the 
        Secretary, in accordance with the purpose described in 
        subsection (a), shall establish and implement procedures under 
        which an entity may submit a request to an entity with a 
        contract under this subsection to develop a report based on--
                    ``(A) Federal health care data disclosed to the 
                entity under paragraph (5); and
                    ``(B) private data that is publicly available or is 
                provided to the entity by the entity making the request 
                for the report.
            ``(5) Access to federal health care data.--
                    ``(A) In general.--The procedures established under 
                paragraph (4) shall provide for the secure disclosure 
                of Federal health care data to each entity with a 
                contract under paragraph (2).
                    ``(B) Update information.--Not less than every 6 
                months, the Secretary shall update the information 
                disclosed under subparagraph (A) to each such entity.
    ``(g) Public Reporting of Quality Resource Use Measures at the 
Provider, Group, System, Regional, and Other Levels.--The Secretary 
shall make aggregated data, and reports developed under subsection (f), 
on quality and resource use measures collected under this section 
available to health care providers and the public through the process 
described in 399KK.
    ``(h) Research Access to Health Care Data and Reporting on 
Performance.--The Secretary shall permit researchers that meet criteria 
used to evaluate the appropriateness of the release data for research 
purposes (as established by the Secretary) to--
            ``(1) have access to Federal health care data (as defined 
        in subsection (f)); and
            ``(2) report on the performance of health care providers 
        and suppliers, including reporting in a provider- or supplier-
        identifiable format.
    ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $90,000,000 for each of fiscal 
years 2010 through 2014.''.
    (b) HIT Policy Committee.--Section 3002(b)(2)(B) of the Public 
Health Service Act (42 U.S.C. 300jj-12(b)(2)(B)) is amended by adding 
at the end the following:
                            ``(ix) The use of certified electronic 
                        health records to collect and report quality 
                        measures accepted by the Secretary.''.

              Subtitle B--Health Care Quality Improvements

SEC. 211. HEALTH CARE DELIVERY SYSTEM RESEARCH; QUALITY IMPROVEMENT 
              TECHNICAL ASSISTANCE.

    Part D of title IX of the Public Health Service Act, as amended by 
section 203, is further amended by adding at the end the following:

         ``Subpart II--Health Care Quality Improvement Programs

``SEC. 933. HEALTH CARE DELIVERY SYSTEM RESEARCH.

    ``(a) Purpose.--The purposes of this section are to--
            ``(1) enable the Director to identify, develop, evaluate, 
        disseminate, and provide training in innovative methodologies 
        and strategies for quality improvement practices in the 
        delivery of health care services that represent best practices 
        (referred to as `best practices') in health care quality, 
        safety, and value; and
            ``(2) ensure that the Director is accountable for 
        implementing a model to pursue such research in a collaborative 
        manner with other related Federal agencies.
    ``(b) Establishment of Center.--There is established within the 
Agency the Patient Safety Research Center (referred to in this section 
as the `Center').
    ``(c) General Functions of Center.--The Center shall--
            ``(1) carry out its functions using research from a variety 
        of disciplines, which may include epidemiology, health 
        services, sociology, psychology, human factors engineering, 
        biostatistics, health economics, clinical research, and health 
        informatics;
            ``(2) conduct or support activities for activities 
        identified in subsection (a), and for--
                    ``(A) best practices for quality improvement 
                practices in the delivery of health care services; and
                    ``(B) that include changes in processes of care and 
                the redesign of systems used by providers that will 
                reliably result in intended health outcomes, improve 
                patient safety, and reduce medical errors (such as 
                skill development for health care providers in team-
                based health care delivery and rapid cycle process 
                improvement) and facilitate adoption of improved 
                workflow;
            ``(3) identify health care providers, including health care 
        systems, single institutions, and individual providers, that--
                    ``(A) deliver consistently high-quality, efficient 
                health care services (as determined by the Secretary); 
                and
                    ``(B) employ best practices that are adaptable and 
                scalable to diverse health care settings or effective 
                in improving care across diverse settings;
            ``(4) assess research, evidence, and knowledge about what 
        strategies and methodologies are most effective in improving 
        health care delivery;
            ``(5) find ways to translate such information rapidly and 
        effectively into practice, and document the sustainability of 
        those improvements;
            ``(6) create strategies for quality improvement through the 
        development of tools, methodologies, and interventions that can 
        successfully reduce variations in the delivery of health care;
            ``(7) identify, measure, and improve organizational, human, 
        or other causative factors, including those related to the 
        culture and system design of a health care organization, that 
        contribute to the success and sustainability of specific 
        quality improvement and patient safety strategies;
            ``(8) provide for the development of best practices in the 
        delivery of health care services that--
                    ``(A) have a high likelihood of success, based on 
                structured review of empirical evidence;
                    ``(B) are specified with sufficient detail of the 
                individual processes, steps, training, skills, and 
                knowledge required for implementation and incorporation 
                into workflow of health care practitioners in a variety 
                of settings;
                    ``(C) are designed to be readily adapted by health 
                care providers in a variety of settings; and
                    ``(D) where applicable, assist health care 
                providers in working with other health care providers 
                across the continuum of care and in engaging patients 
                and their families in improving the care and patient 
                health outcomes;
            ``(9) provide for the funding of the activities of 
        organizations with recognized expertise and excellence in 
        improving the delivery of health care services, including 
        children's health care, by involving multiple disciplines, 
        managers of health care entities, broad development and 
        training, patients, caregivers and families, and frontline 
        health care workers, including activities for the examination 
        of strategies to share best quality improvement practices and 
        to promote excellence in the delivery of health care services; 
        and
            ``(10) build capacity at the State and community level to 
        lead quality and safety efforts through education, training, 
        and mentoring programs to carry out the activities under 
        paragraphs (1) through (9).
    ``(d) Research Functions of Center.--
            ``(1) In general.--The Center shall support, such as 
        through a contract or other mechanism, research on health care 
        delivery system improvement and the development of tools to 
        facilitate adoption of best practices that improve the quality, 
        safety, and efficiency of health care delivery services. Such 
        support may include establishing a Quality Improvement Network 
        Research Program for the purpose of testing, scaling, and 
        disseminating of interventions to improve quality and 
        efficiency in health care. Recipients of funding under the 
        Program may include national, State, multi-State, or multi-site 
        quality improvement networks.
            ``(2) Research requirements.--The research conducted 
        pursuant to paragraph (1) shall--
                    ``(A) address the priorities identified by the 
                Secretary in the national strategic plan established 
                under section 399HH;
                    ``(B) identify areas in which evidence is 
                insufficient to identify strategies and methodologies, 
                taking into consideration areas of insufficient 
                evidence identified by a qualified consensus-based 
                entity in the report required under section 399JJ;
                    ``(C) address concerns identified by health care 
                institutions and providers and communicated through the 
                Center pursuant to subsection (e);
                    ``(D) reduce preventable morbidity, mortality, and 
                associated costs of morbidity and mortality by building 
                capacity for patient safety research;
                    ``(E) support the discovery of processes for the 
                reliable, safe, efficient, and responsive delivery of 
                health care, taking into account discoveries from 
                clinical research and comparative effectiveness 
                research;
                    ``(F) be designed to help improve health care 
                quality and is tested in practice-based settings;
                    ``(G) allow communication of research findings and 
                translate evidence into practice recommendations that 
                are adaptable to a variety of settings, and which, as 
                soon as practicable after the establishment of the 
                Center, shall include--
                            ``(i) the implementation of a national 
                        application of Intensive Care Unit improvement 
                        projects relating to the adult (including 
                        geriatric), pediatric, and neonatal patient 
                        populations;
                            ``(ii) practical methods for addressing 
                        health care associated infections, including 
                        Methicillin-Resistant Staphylococcus Aureus and 
                        Vancomycin-Resistant Entercoccus infections and 
                        other emerging infections; and
                            ``(iii) practical methods for reducing 
                        preventable hospital admissions and 
                        readmissions;
                    ``(H) expand demonstration projects for improving 
                the quality of children's health care and the use of 
                health information technology, such as through 
                Pediatric Quality Improvement Collaboratives and 
                Learning Networks, consistent with provisions of 
                section 1139A of the Social Security Act for assessing 
                and improving quality, where applicable;
                    ``(I) identify and mitigate hazards by--
                            ``(i) analyzing events reported to patient 
                        safety reporting systems and patient safety 
                        organizations; and
                            ``(ii) using the results of such analyses 
                        to develop scientific methods of response to 
                        such events;
                    ``(J) include the conduct of systematic reviews of 
                existing practices that improve the quality, safety, 
                and efficiency of health care delivery, as well as new 
                research on improving such practices; and
                    ``(K) include the examination of how to measure and 
                evaluate the progress of quality and patient safety 
                activities.
    ``(e) Dissemination of Research Findings.--
            ``(1) Public availability.--The Director shall make the 
        research findings of the Center available to the public through 
        multiple media and appropriate formats to reflect the varying 
        needs of health care providers and consumers and diverse levels 
        of health literacy.
            ``(2) Linkage to health information technology.--The 
        Secretary shall ensure that research findings and results 
        generated by the Center are shared with the Office of the 
        National Coordinator of Health Information Technology and used 
        to inform the activities of the health information technology 
        extension program under section 3012, as well as any relevant 
        standards, certification criteria, or implementation 
        specifications.
    ``(f) Prioritization.--The Director shall identify and regularly 
update a list of processes or systems on which to focus research and 
dissemination activities of the Center, taking into account--
            ``(1) cost to Federal health programs;
            ``(2) consumer assessment of health care experience;
            ``(3) provider assessment of such processes or systems and 
        opportunities to minimize distress and injury to the health 
        care workforce;
            ``(4) potential impact of such processes or systems on 
        health status and function of patients, including vulnerable 
        populations including children;
            ``(5) areas of insufficient evidence identified under 
        subsection (d)(2)(B); and
            ``(6) the evolution of meaningful use of health information 
        technology, as defined in section 3000.
    ``(g) Funding.--There is authorized to be appropriated to carry out 
this section $20,000,000 for fiscal years 2010 through 2014.

``SEC. 934. QUALITY IMPROVEMENT TECHNICAL ASSISTANCE AND 
              IMPLEMENTATION.

    ``(a) In General.--The Director, through the Patient Safety 
Research Center established in section 933 (referred to in this section 
as the `Center'), shall award--
            ``(1) technical assistance grants or contracts to eligible 
        entities to provide technical support to institutions that 
        deliver health care and health care providers so that such 
        institutions and providers understand, adapt, and implement the 
        models and practices identified in the research conducted by 
        the Center, including the Quality Improvement Networks Research 
        Program; and
            ``(2) implementation grants or contracts to eligible 
        entities to implement the models and practices described under 
        paragraph (1).
    ``(b) Eligible Entities.--
            ``(1) Technical assistance award.--To be eligible to 
        receive a technical assistance grant or contract under 
        subsection (a)(1), an entity--
                    ``(A) may be a health care provider, health care 
                provider association, professional society, health care 
                worker organization, Indian health organization, 
                quality improvement organization, patient safety 
                organization, local quality improvement collaborative, 
                the Joint Commission, academic health center, 
                university, physician-based research network, primary 
                care extension program established under section 399V, 
                a Federal Indian Health Service program or a health 
                program operated by an Indian Tribe (as defined in 
                section 4 of the Indian Health Care Improvement Act), 
                or any other entity identified by the Secretary; and
                    ``(B) shall have demonstrated expertise in 
                providing information and technical support and 
                assistance to health care providers regarding quality 
                improvement.
            ``(2) Implementation award.--To be eligible to receive an 
        implementation grant or contract under subsection (a)(2), an 
        entity--
                    ``(A) may be a hospital or other health care 
                provider or consortium or providers, as determined by 
                the Secretary; and
                    ``(B) shall have demonstrated expertise in 
                providing information and technical support and 
                assistance to health care providers regarding quality 
                improvement.
    ``(c) Application.--
            ``(1) Technical assistance award.--To receive a technical 
        assistance grant or contract under subsection (a)(1), an 
        eligible entity shall submit an application to the Secretary at 
        such time, in such manner, and containing--
                    ``(A) a plan for a sustainable business model that 
                may include a system of--
                            ``(i) charging fees to institutions and 
                        providers that receive technical support from 
                        the entity; and
                            ``(ii) reducing or eliminating such fees 
                        for such institutions and providers that serve 
                        low-income populations; and
                    ``(B) such other information as the Director may 
                require.
            ``(2) Implementation award.--To receive a grant or contract 
        under subsection (a)(2), an eligible entity shall submit an 
        application to the Secretary at such time, in such manner, and 
        containing--
                    ``(A) a plan for implementation of a model or 
                practice identified in the research conducted by the 
                Center including--
                            ``(i) financial cost, staffing 
                        requirements, and timeline for implementation; 
                        and
                            ``(ii) pre- and projected post-
                        implementation quality measure performance data 
                        in targeted improvement areas identified by the 
                        Secretary; and
                    ``(B) such other information as the Director may 
                require.
    ``(d) Matching Funds.--The Director may not award a grant or 
contract under this section to an entity unless the entity agrees that 
it will make available (directly or through contributions from other 
public or private entities) non-Federal contributions toward the 
activities to be carried out under the grant or contract in an amount 
equal to $1 for each $5 of Federal funds provided under the grant or 
contract. Such non-Federal matching funds may be provided directly or 
through donations from public or private entities and may be in cash or 
in-kind, fairly evaluated, including plant, equipment, or services.
    ``(e) Evaluation.--
            ``(1) In general.--The Director shall evaluate the 
        performance of each entity that receives a grant or contract 
        under this section. The evaluation of an entity shall include a 
        study of--
                    ``(A) the success of such entity in achieving the 
                implementation, by the health care institutions and 
                providers assisted by such entity, of the models and 
                practices identified in the research conducted by the 
                Center under section 933;
                    ``(B) the perception of the health care 
                institutions and providers assisted by such entity 
                regarding the value of the entity; and
                    ``(C) where practicable, better patient health 
                outcomes and lower cost resulting from the assistance 
                provided by such entity.
            ``(2) Effect of evaluation.--Based on the outcome of the 
        evaluation of the entity under paragraph (1), the Director 
        shall determine whether to renew a grant or contract with such 
        entity under this section.
    ``(f) Coordination.--The entities that receive a grant or contract 
under this section shall coordinate with health information technology 
regional extension centers under section 3012(c) and the primary care 
extension program established under section 399V regarding the 
dissemination of quality improvement, system delivery reform, and best 
practices information.''.

SEC. 212. GRANTS TO ESTABLISH COMMUNITY HEALTH TEAMS TO SUPPORT THE 
              PATIENT-CENTERED MEDICAL HOME.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall establish a 
program to provide grants to eligible entities to establish community-
based interdisciplinary, interprofessional teams (referred to in this 
section as ``health teams'') to support primary care practices, 
including obstetrics and gynecology practices, within the hospital 
service areas served by the eligible entities. Grants shall be used 
to--
            (1) establish health teams to provide support services to 
        primary care providers; and
            (2) provide capitated payments to primary care providers as 
        determined by the Secretary.
    (b) Eligible Entities.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            (1)(A) be a State or State-designated entity; or
            [(B) be an Indian Tribe or tribal organization, as defined 
        in section 4 of the Indian Health Care Improvement Act;]
            (2) submit a plan for achieving long-term financial 
        sustainability within 3 years;
            (3) submit a plan for incorporating prevention initiatives 
        and patient education and care management resources into the 
        delivery of health care that is integrated with community-based 
        prevention and treatment resources, where available;
            (4) ensure that the health team established by the entity 
        includes an interdisciplinary, interprofessional team of health 
        care providers, as determined by the Secretary; such team may 
        include medical specialists, nurses, nutritionists, dieticians, 
        social workers, behavioral and mental health providers 
        (including substance use disorder prevention and treatment 
        providers), doctors of chiropractic, licensed complementary and 
        alternative medicine practitioners, and physicians' assistants; 
        and
            (5) submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary 
        may require.
    (c) Requirements for Health Teams.--A health team established 
pursuant to a grant under subsection (a) shall--
            (1) establish contractual agreements with primary care 
        providers to provide support services;
            (2) support patient-centered medical homes, defined as mode 
        of care that includes--
                    (A) personal physicians;
                    (B) whole person orientation;
                    (C) coordinated and integrated care;
                    (D) safe and high quality care though evidence-
                informed medicine, appropriate use of health 
                information technology, and continuous quality 
                improvements;
                    (E) expanded access to care; and
                    (F) payment that recognizes added value from 
                additional components of patient-centered care;
            (3) collaborate with local primary care providers and 
        existing State and community based resources to coordinate 
        disease prevention, chronic disease management, transitioning 
        between health care providers and settings and case management 
        for patients, including children, with priority given to those 
        amenable to prevention and with chronic diseases or conditions 
        identified by the Secretary;
            (4) in collaboration with local health care providers, 
        develop and implement interdisciplinary, interprofessional care 
        plans that integrate clinical and community preventive and 
        health promotion services for patients, including children, 
        with a priority given to those amenable to prevention and with 
        chronic diseases or conditions identified by the Secretary;
            (5) incorporate health care providers, patients, 
        caregivers, and authorized representatives in program design 
        and oversight;
            (6) provide support necessary for local primary care 
        providers to--
                    (A) coordinate and provide access to high-quality 
                health care services;
                    (B) coordinate and provide access to preventive and 
                health promotion services;
                    (C) provide access to appropriate specialty care 
                and inpatient services;
                    (D) provide quality-driven, cost-effective, 
                culturally appropriate, and patient- and family-
                centered health care;
                    (E) provide access to pharmacist-delivered 
                medication management services, including medication 
                reconciliation;
                    (F) provide coordination of the appropriate use of 
                complementary and alternative (CAM) services to those 
                who request such services;
                    (G) promote effective strategies for treatment 
                planning, monitoring health outcomes and resource use, 
                sharing information, treatment decision support, and 
                organizing care to avoid duplication of service and 
                other medical management approaches intended to improve 
                quality and value of health care services;
                    (H) provide local access to the continuum of health 
                care services in the most appropriate setting, 
                including access to individuals that implement the care 
                plans of patients and coordinate care, such as 
                integrative health care practitioners;
                    (I) collect and report data that permits evaluation 
                of the success of the collaborative effort on patient 
                outcomes, including collection of data on patient 
                experience of care, and identification of areas for 
                improvement; and
                    (J) establish a coordinated system of early 
                identification and referral for children at risk for 
                developmental or behavioral problems such as through 
                the use of infolines, health information technology, or 
                other means as determined by the Secretary;
            (7) provide 24-hour care management and support during 
        transitions in care settings including--
                    (A) a transitional care program that provides 
                onsite visits from the care coordinator, assists with 
                the development of discharge plans and medication 
                reconciliation upon admission to and discharge from the 
                hospitals, nursing home, or other institution setting;
                    (B) discharge planning and counseling support to 
                providers, patients, caregivers, and authorized 
                representatives;
                    (C) assuring that post-discharge care plans include 
                medication management, as appropriate;
                    (D) referrals for mental and behavioral health 
                services, which may include the use of infolines; and
                    (E) transitional health care needs from adolescence 
                to adulthood;
            (8) serve as a liaison to community prevention and 
        treatment programs;
            (9) demonstrate a capacity to implement and maintain health 
        information technology that meets the requirements of certified 
        EHR technology (as defined in section 3000 of the Public Health 
        Service Act (42 U.S.C. 300jj)) to facilitate coordination among 
        members of the applicable care team and affiliated primary care 
        practices; and
            (10) where applicable, report to the Secretary information 
        on quality measures used under section 399JJ of the Public 
        Health Service Act.
    (d) Requirement for Primary Care Providers.--A provider who 
contracts with a care team shall--
            (1) provide a care plan to the care team for each patient 
        participant;
            (2) provide access to participant health records; and
            (3) meet regularly with the care team to ensure integration 
        of care.
    (e) Reporting to Secretary.--An entity that receives a grant under 
subsection (a) shall submit to the Secretary a report that describes 
and evaluates, as requested by the Secretary, the activities carried 
out by the entity under subsection (c).
    (f) Definition of Primary Care.--In this section, the term 
``primary care'' means the provision of integrated, accessible health 
care services by clinicians who are accountable for addressing a large 
majority of personal health care needs, developing a sustained 
partnership with patients, and practicing in the context of family and 
community.

SEC. 213. GRANTS TO IMPLEMENT MEDICATION MANAGEMENT SERVICES IN 
              TREATMENT OF CHRONIC DISEASE.

    Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.), 
as amended by section 211, is further amended by inserting after 
section 934 the following:

``SEC. 935. GRANTS TO IMPLEMENT MEDICATION MANAGEMENT SERVICES IN 
              TREATMENT OF CHRONIC DISEASES.

    ``(a) In General.--The Secretary, acting through the Patient Safety 
Research Center established in section 933 (referred to in this section 
as the `Center'), shall establish a program to provide grants to 
eligible entities to implement medication management (referred to in 
this section as `MTM') services provided by licensed pharmacists, as a 
collaborative, multidisciplinary, inter-professional approach to the 
treatment of chronic diseases for targeted individuals, to improve the 
quality of care and reduce overall cost in the treatment of such 
diseases. The Secretary shall commence the grant program not later than 
May 1, 2010.
    ``(b) Eligible Entities.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) provide a setting appropriate for MTM services, as 
        recommended by the experts described in subsection (e);
            ``(2) submit to the Secretary a plan for achieving long-
        term financial sustainability;
            ``(3) where applicable, submit a plan for coordinating MTM 
        services through local community health teams established in 
        section 212 of the Affordable Health Choices Act or in 
        collaboration with primary care extension programs established 
        in section 399V;
            ``(4) submit a plan for meeting the requirements under 
        subsection (c); and
            ``(5) submit to the Secretary such other information as the 
        Secretary may require.
    ``(c) MTM Services to Targeted Individuals.--The MTM services 
provided with the assistance of a grant awarded under subsection (a) 
shall, as allowed by State law including applicable collaborative 
pharmacy practice agreements, include--
            ``(1) performing or obtaining necessary assessments of the 
        health and functional status of each patient receiving such MTM 
        services;
            ``(2) formulating a medication treatment plan according to 
        therapeutic goals agreed upon by the prescriber and the patient 
        or caregiver or authorized representative of the patient;
            ``(3) selecting, initiating, modifying, recommending 
        changes to, or administering medication therapy;
            ``(4) monitoring, which may include access to, ordering, or 
        performing laboratory assessments, and evaluating the response 
        of the patient to therapy, including safety and effectiveness;
            ``(5) performing an initial comprehensive medication review 
        to identify, resolve, and prevent medication-related problems, 
        including adverse drug events, quarterly targeted medication 
        reviews for ongoing monitoring, and additional followup 
        interventions on a schedule developed collaboratively with the 
        prescriber;
            ``(6) documenting the care delivered and communicating 
        essential information about such care, including a summary of 
        the medication review, and the recommendations of the 
        pharmacist to other appropriate health care providers of the 
        patient in a timely fashion;
            ``(7) providing education and training designed to enhance 
        the understanding and appropriate use of the medications by the 
        patient, caregiver, and other authorized representative;
            ``(8) providing information, support services, and 
        resources and strategies designed to enhance patient adherence 
        with therapeutic regimens;
            ``(9) coordinating and integrating MTM services within the 
        broader health care management services provided to the 
        patient; and
            ``(10) such other patient care services allowed under 
        pharmacist scopes of practice in use in other Federal programs 
        that have implemented MTM services.
    ``(d) Targeted Individuals.--MTM services provided by licensed 
pharmacists under a grant awarded under subsection (a) shall be offered 
to targeted individuals who--
            ``(1) take 4 or more prescribed medications (including 
        over-the-counter medications and dietary supplements);
            ``(2) take any `high risk' medications;
            ``(3) have 2 or more chronic diseases, as identified by the 
        Secretary; or
            ``(4) have undergone a transition of care, or other 
        factors, as determined by the Secretary, that are likely to 
        create a high risk of medication-related problems.
    ``(e) Consultation With Experts.--In designing and implementing MTM 
services provided under grants awarded under subsection (a), the 
Secretary shall consult with Federal, State, private, public-private, 
and academic entities, pharmacy and pharmacist organizations, health 
care organizations, consumer advocates, chronic disease groups, and 
other stakeholders involved with the research, dissemination, and 
implementation of pharmacist-delivered MTM services, as the Secretary 
determines appropriate. The Secretary, in collaboration with this 
group, shall determine whether it is possible to incorporate rapid 
cycle process improvement concepts in use in other Federal programs 
that have implemented MTM services.
    ``(f) Reporting to the Secretary.--An entity that receives a grant 
under subsection (a) shall submit to the Secretary a report that 
describes and evaluates, as requested by the Secretary, the activities 
carried out under subsection (c), including quality measures endorsed 
under 399JJ, as determined by the Secretary.
    ``(g) Evaluation and Report.--The Secretary shall submit to the 
relevant committees of Congress a report which shall--
            ``(1) assess the clinical effectiveness of pharmacist-
        provided services under the MTM services program, as compared 
        to usual care, including an evaluation of whether enrollees 
        maintained better health with fewer hospitalizations and 
        emergency room visits than similar patients not enrolled in the 
        program;
            ``(2) assess changes in overall health care resource use by 
        targeted individuals;
            ``(3) assess patient and prescriber satisfaction with MTM 
        services;
            ``(4) assess the impact of patient-cost sharing 
        requirements on medication adherence and recommendations for 
        modifications;
            ``(5) identify and evaluate other factors that may impact 
        clinical and economic outcomes, including demographic 
        characteristics, clinical characteristics, and health services 
        use of the patient, as well as characteristics of the regimen, 
        pharmacy benefit, and MTM services provided; and
            ``(6) evaluate the extent to which participating 
        pharmacists who maintain a dispensing role have a conflict of 
        interest in the provision of MTM services, and if such conflict 
        is found, provide recommendations on how such a conflict might 
        be appropriately addressed.
    ``(h) Grant to Fund Development of Performance Measures.--Secretary 
may, through the quality measure development program under section 931 
of the Public Health Service Act, award grants or contracts to eligible 
entities for the purpose of funding the development of performance 
measures that assess the use and effectiveness of medication therapy 
management services.''.

SEC. 214. DESIGN AND IMPLEMENTATION OF REGIONALIZED SYSTEMS FOR 
              EMERGENCY CARE.

    (a) In General.--Title XII of the Public Health Service Act (42 
U.S.C. 300d et seq.) is amended--
            (1) in section 1203--
                    (A) in the section heading, by inserting ``for 
                trauma systems'' after ``grants''; and
                    (B) in subsection (a), by striking ``Administrator 
                of the Health Resources and Services Administration'' 
                and inserting ``Assistant Secretary for Preparedness 
                and Response'';
            (2) by inserting after section 1203 the following:

``SEC. 1204. COMPETITIVE GRANTS FOR REGIONALIZED SYSTEMS FOR EMERGENCY 
              CARE RESPONSE.

    ``(a) In General.--The Secretary, acting through the Assistant 
Secretary for Preparedness and Response, shall award not fewer than 4 
multiyear contracts or competitive grants to eligible entities to 
support pilot projects that design, implement, and evaluate innovative 
models of regionalized, comprehensive, and accountable emergency care 
and trauma systems.
    ``(b) Eligible Entity; Region.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means--
                    ``(A) a State or a partnership of 1 or more States 
                and 1 or more local governments; or
                    ``(B) an Indian Tribe (as defined in section 4 of 
                the Indian Health Care Improvement Act) or a 
                partnership of 1 or more Indian Tribes.
            ``(2) Region.--The term `region' means an area within a 
        State, an area that lies within multiple States, or a similar 
        area (such as a multicounty area), as determined by the 
        Secretary.
            ``(3) Emergency services.--The term `emergency services' 
        includes acute, prehospital, and trauma care.
    ``(c) Pilot Projects.--The Secretary shall award a contract or 
grant under subsection (a) to an eligible entity that proposes a pilot 
project to design, implement, and evaluate an emergency medical and 
trauma system that--
            ``(1) coordinates with public health and safety services, 
        emergency medical services, medical facilities, trauma centers, 
        and other entities in a region to develop an approach to 
        emergency medical and trauma system access throughout the 
        region, including 9-1-1 Public Safety Answering Points and 
        emergency medical dispatch;
            ``(2) includes a mechanism, such as a regional medical 
        direction or transport communications system, that operates 
        throughout the region to ensure that the patient is taken to 
        the medically appropriate facility (whether an initial facility 
        or a higher-level facility) in a timely fashion;
            ``(3) allows for the tracking of prehospital and hospital 
        resources, including inpatient bed capacity, emergency 
        department capacity, trauma center capacity, on-call specialist 
        coverage, ambulance diversion status, and the coordination of 
        such tracking with regional communications and hospital 
        destination decisions; and
            ``(4) includes a consistent region-wide prehospital, 
        hospital, and interfacility data management system that--
                    ``(A) submits data to the National EMS Information 
                System, the National Trauma Data Bank, and others;
                    ``(B) reports data to appropriate Federal and State 
                databanks and registries; and
                    ``(C) contains information sufficient to evaluate 
                key elements of prehospital care, hospital destination 
                decisions, including initial hospital and interfacility 
                decisions, and relevant health outcomes of hospital 
                care.
    ``(d) Application.--
            ``(1) In general.--An eligible entity that seeks a contract 
        or grant described in subsection (a) shall submit to the 
        Secretary an application at such time and in such manner as the 
        Secretary may require.
            ``(2) Application information.--Each application shall 
        include--
                    ``(A) an assurance from the eligible entity that 
                the proposed system--
                            ``(i) has been coordinated with the 
                        applicable State Office of Emergency Medical 
                        Services (or equivalent State office);
                            ``(ii) includes consistent indirect and 
                        direct medical oversight of prehospital, 
                        hospital, and interfacility transport 
                        throughout the region;
                            ``(iii) coordinates prehospital treatment 
                        and triage, hospital destination, and 
                        interfacility transport throughout the region;
                            ``(iv) includes a categorization or 
                        designation system for special medical 
                        facilities throughout the region that is 
                        integrated with transport and destination 
                        protocols;
                            ``(v) includes a regional medical 
                        direction, patient tracking, and resource 
                        allocation system that supports day-to-day 
                        emergency care and surge capacity and is 
                        integrated with other components of the 
                        national and State emergency preparedness 
                        system; and
                            ``(vi) addresses pediatric concerns related 
                        to integration, planning, preparedness, and 
                        coordination of emergency medical services for 
                        infants, children and adolescents; and
                    ``(B) such other information as the Secretary may 
                require.
    ``(e) Requirement of Matching Funds.--
            ``(1) In general.--The Secretary may not make a grant under 
        this section unless the State (or consortia of States) involved 
        agrees, with respect to the costs to be incurred by the State 
        (or consortia) in carrying out the purpose for which such grant 
        was made, to make available non-Federal contributions (in cash 
        or in kind under paragraph (2)) toward such costs in an amount 
        equal to not less than $1 for each $3 of Federal funds provided 
        in the grant. Such contributions may be made directly or 
        through donations from public or private entities.
            ``(2) Non-federal contributions.--Non-Federal contributions 
        required in paragraph (1) may be in cash or in kind, fairly 
        evaluated, including equipment or services (and excluding 
        indirect or overhead costs). Amounts provided by the Federal 
        Government, or services assisted or subsidized to any 
        significant extent by the Federal Government, may not be 
        included in determining the amount of such non-Federal 
        contributions.
    ``(f) Priority.--The Secretary shall give priority for the award of 
the contracts or grants described in subsection (a) to any eligible 
entity that serves a population in a medically underserved area (as 
defined in section 330(b)(3)).
    ``(g) Report.--Not later than 90 days after the completion of a 
pilot project under subsection (a), the recipient of such contract or 
grant described in shall submit to the Secretary a report containing 
the results of an evaluation of the program, including an 
identification of--
            ``(1) the impact of the regional, accountable emergency 
        care and trauma system on patient health outcomes for various 
        critical care categories, such as trauma, stroke, cardiac 
        emergencies, neurological emergencies, and pediatric 
        emergencies;
            ``(2) the system characteristics that contribute to the 
        effectiveness and efficiency of the program (or lack thereof);
            ``(3) methods of assuring the long-term financial 
        sustainability of the emergency care and trauma system;
            ``(4) the State and local legislation necessary to 
        implement and to maintain the system;
            ``(5) the barriers to developing regionalized, accountable 
        emergency care and trauma systems, as well as the methods to 
        overcome such barriers; and
            ``(6) recommendations on the utilization of available 
        funding for future regionalization efforts.
    ``(h) Dissemination of Findings.--The Secretary shall, as 
appropriate, disseminate to the public and to the appropriate 
Committees of the Congress, the information contained in a report made 
under subsection (g).''; and
            (3) in section 1232--
                    (A) in subsection (a), by striking ``appropriated'' 
                and all that follows through the period at the end and 
                inserting ``appropriated $24,000,000 for each of fiscal 
                years 2010 through 2014.''; and
                    (B) by inserting after subsection (c) the 
                following:
    ``(d) Authority.--For the purpose of carrying out parts A through 
C, beginning on the date of enactment of the Affordable Health Choices 
Act, the Secretary shall transfer authority in administering grants and 
related authorities under such parts from the Administrator of the 
Health Resources and Services Administration to the Assistant Secretary 
for Preparedness and Response.''.
    (b) Support for Emergency Medicine Research.--Part H of title IV of 
the Public Health Service Act (42 U.S.C. 289 et seq.) is amended by 
inserting after the section 498C the following:

``SEC. 498D. SUPPORT FOR EMERGENCY MEDICINE RESEARCH.

    ``(a) Emergency Medical Research.--The Secretary shall support 
Federal programs administered by the National Institutes of Health, the 
Agency for Healthcare Research and Quality, the Health Resources and 
Services Administration, the Centers for Disease Control and 
Prevention, and other agencies involved in improving the emergency care 
system to expand and accelerate research in emergency medical care 
systems and emergency medicine, including--
            ``(1) the basic science of emergency medicine;
            ``(2) the model of service delivery and the components of 
        such models that contribute to enhanced patient health 
        outcomes;
            ``(3) the translation of basic scientific research into 
        improved practice; and
            ``(4) the development of timely and efficient delivery of 
        health services.
    ``(b) Pediatric Emergency Medical Research.--The Secretary shall 
support Federal programs administered by the National Institutes of 
Health, the Agency for Healthcare Research and Quality, the Health 
Resources and Services Administration, the Centers for Disease Control 
and Prevention, and other agencies to coordinate and expand research in 
pediatric emergency medical care systems and pediatric emergency 
medicine, including--
            ``(1) an examination of the gaps and opportunities in 
        pediatric emergency care research and a strategy for the 
        optimal organization and funding of such research;
            ``(2) the role of pediatric emergency services as an 
        integrated component of the overall health system;
            ``(3) system-wide pediatric emergency care planning, 
        preparedness, coordination, and funding;
            ``(4) pediatric training in professional education; and
            ``(5) research in pediatric emergency care, specifically on 
        the efficacy, safety, and health outcomes of medications used 
        for infants, children, and adolescents in emergency care 
        settings in order to improve patient safety.
    ``(c) Impact Research.--The Secretary shall support research to 
determine the estimated economic impact of, and savings that result 
from, the implementation of coordinated emergency care systems.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2014.''.

SEC. 215. TRAUMA CARE CENTERS AND SERVICE AVAILABILITY.

    (a) Trauma Care Centers.--
            (1) Grants for trauma care centers.--Section 1241 of the 
        Public Health Service Act (42 U.S.C. 300d-41) is amended by 
        striking subsections (a) and (b) and inserting the following:
    ``(a) In General.--The Secretary shall establish 3 programs to 
award grants to qualified public, nonprofit, Indian Health Service, 
Indian tribal, and urban Indian trauma centers--
            ``(1) to assist in defraying substantial uncompensated care 
        costs;
            ``(2) to further the core missions of such trauma centers, 
        including by addressing costs associated with patient 
        stabilization and transfer, trauma education and outreach, 
        coordination with local and regional trauma systems, essential 
        personnel and other fixed costs, and expenses associated with 
        employee and non-employee physician services; and
            ``(3) to provide emergency relief to ensure the continued 
        and future availability of trauma services.
    ``(b) Minimum Qualifications of Trauma Centers.--
            ``(1) Participation in trauma care system operating under 
        certain professional guidelines.--Except as provided in 
        paragraph (2), the Secretary may not award a grant to a trauma 
        center under subsection (a) unless the trauma center is a 
        participant in a trauma system that substantially complies with 
        section 1213.
            ``(2) Exemption.--Paragraph (1) shall not apply to trauma 
        centers that are located in States with no existing trauma care 
        system.
            ``(3) Qualification for substantial uncompensated care 
        costs.--The Secretary shall award substantial uncompensated 
        care grants under subsection (a)(1) only to trauma centers 
        meeting at least 1 of the criteria in 1 of the following 3 
        categories:
                    ``(A) Category a.--The criteria for category A are 
                as follows:
                            ``(i) At least 40 percent of the visits in 
                        the emergency department of the hospital in 
                        which the trauma center is located were charity 
                        or self-pay patients.
                            ``(ii) At least 50 percent of the visits in 
                        such emergency department were Medicaid (under 
                        title XIX of the Social Security Act (42 U.S.C. 
                        1396 et seq.)) and charity and self-pay 
                        patients combined.
                    ``(B) Category b.--The criteria for category B are 
                as follows:
                            ``(i) At least 35 percent of the visits in 
                        the emergency department were charity or self-
                        pay patients.
                            ``(ii) At least 50 percent of the visits in 
                        the emergency department were Medicaid and 
                        charity and self-pay patients combined.
                    ``(C) Category c.--The criteria for category C are 
                as follows:
                            ``(i) At least 20 percent of the visits in 
                        the emergency department were charity or self-
                        pay patients.
                            ``(ii) At least 30 percent of the visits in 
                        the emergency department were Medicaid and 
                        charity and self-pay patients combined.
            ``(4) Trauma centers in 1115 waiver states.--
        Notwithstanding paragraph (3), the Secretary may award a 
        substantial uncompensated care grant to a trauma center under 
        subsection (a)(1) if the trauma center qualifies for funds 
        under a Low Income Pool or Safety Net Care Pool established 
        through a waiver approved under section 1115 of the Social 
        Security Act (42 U.S.C. 1315).
            ``(5) Designation.--The Secretary may not award a grant to 
        a trauma center unless such trauma center is verified by the 
        American College of Surgeons or designated by an equivalent 
        State or local agency.
    ``(c) Additional Requirements.--The Secretary may not award a grant 
to a trauma center under subsection (a)(1) unless such trauma center--
            ``(1) submits to the Secretary a plan satisfactory to the 
        Secretary that demonstrates a continued commitment to serving 
        trauma patients regardless of their ability to pay; and
            ``(2) has policies in place to assist patients who cannot 
        pay for part or all of the care they receive, including a 
        sliding fee scale, and to ensure fair billing and collection 
        practices.''.
            (2) Considerations in making grants.--Section 1242 of the 
        Public Health Service Act (42 U.S.C. 300d-42) is amended by 
        striking subsections (a) and (b) and inserting the following:
    ``(a) Substantial Uncompensated Care Awards.--
            ``(1) In general.--The Secretary shall establish an award 
        basis for each eligible trauma center for grants under section 
        1241(a)(1) according to the percentage described in paragraph 
        (2), subject to the requirements of section 1241(b)(3).
            ``(2) Percentages.--The applicable percentages are as 
        follows:
                    ``(A) With respect to a category A trauma center, 
                100 percent of the uncompensated care costs.
                    ``(B) With respect to a category B trauma center, 
                not more than 75 percent of the uncompensated care 
                costs.
                    ``(C) With respect to a category C trauma center, 
                not more than 50 percent of the uncompensated care 
                costs.
    ``(b) Core Mission Awards.--
            ``(1) In general.--In awarding grants under section 
        1241(a)(2), the Secretary shall--
                    ``(A) reserve 25 percent of the amount allocated 
                for core mission awards for Level III and Level IV 
                trauma centers; and
                    ``(B) reserve 25 percent of the amount allocated 
                for core mission awards for large urban Level I and II 
                trauma centers--
                            ``(i) that have at least 1 graduate medical 
                        education fellowship in trauma or trauma 
                        related specialties for which demand is 
                        exceeding supply;
                            ``(ii) for which--
                                    ``(I) annual uncompensated care 
                                costs exceed $10,000,000; or
                                    ``(II) at least 20 percent of 
                                emergency department visits are charity 
                                or self-pay or Medicaid patients; and
                            ``(iii) that are not eligible for 
                        substantial uncompensated care awards under 
                        section 1241(a)(1).
    ``(c) Emergency Awards.--In awarding grants under section 
1241(a)(3), the Secretary shall--
            ``(1) give preference to any application submitted by a 
        trauma center that provides trauma care in a geographic area in 
        which the availability of trauma care has significantly 
        decreased or will significantly decrease if the center is 
        forced to close or downgrade service or growth in demand for 
        trauma services exceeds capacity; and
            ``(2) reallocate any emergency awards funds not obligated 
        due to insufficient, or a lack of qualified, applications to 
        the significant uncompensated care award program.''.
            (3) Certain agreements.--Section 1243 of the Public Health 
        Service Act (42 U.S.C. 300d-43) is amended by striking 
        subsections (a), (b), and (c) and inserting the following:
    ``(a) Maintenance of Financial Support.--The Secretary may require 
a trauma center receiving a grant under section 1241(a) to maintain 
access to trauma services at comparable levels to the prior year during 
the grant period .
    ``(b) Trauma Care Registry.--The Secretary may require the trauma 
center receiving a grant under section 1241(a) to provide data to a 
national and centralized registry of trauma cases, in accordance with 
guidelines developed by the American College of Surgeons, and as the 
Secretary may otherwise require.''.
            (4) General provisions.--Section 1244 of the Public Health 
        Service Act (42 U.S.C. 300d-44) is amended by striking 
        subsections (a), (b), and (c) and inserting the following:
    ``(a) Application.--The Secretary may not award a grant to a trauma 
center under section 1241(a) unless such center submits an application 
for the grant to the Secretary and the application is in such form, is 
made in such manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to carry out 
this part.
    ``(b) Limitation on Duration of Support.--The period during which a 
trauma center receives payments under a grant under section 1241(a)(3) 
shall be for 3 fiscal years, except that the Secretary may waive such 
requirement for a center and authorize such center to receive such 
payments for 1 additional fiscal year.
    ``(c) Limitation on Amount of Grant.--Notwithstanding section 
1242(a), a grant under section 1241 may not be made in an amount 
exceeding $2,000,000 for each fiscal year.
    ``(d) Eligibility.--Except as provided in section 
1242(b)(1)(B)(iii), acquisition of, or eligibility for, a grant under 
section 1241(a) shall not preclude a trauma center from being eligible 
for other grants described in such section.
    ``(e) Funding Distribution.--Of the total amount appropriated for a 
fiscal year under section 1245, 70 percent shall be used for 
substantial uncompensated care awards under section 1241(a)(1), 20 
percent shall be used for core mission awards under section 1241(a)(2), 
and 10 percent shall be used for emergency awards under section 
1241(a)(3).
    ``(f) Minimum Allowance.--Notwithstanding subsection (e), if the 
amount appropriated for a fiscal year under section 1245 is less than 
$25,000,000, all available funding for such fiscal year shall be used 
for substantial uncompensated care awards under section 1241(a)(1).
    ``(g) Substantial Uncompensated Care Award Distribution and 
Proportional Share.--Notwithstanding section 1242(a), of the amount 
appropriated for substantial uncompensated care grants for a fiscal 
year, the Secretary shall--
            ``(1) make available--
                    ``(A) 50 percent of such funds for category A 
                trauma center grantees;
                    ``(B) 35 percent of such funds for category B 
                trauma center grantees; and
                    ``(C) 15 percent of such funds for category C 
                trauma center grantees; and
            ``(2) provide available funds within each category in a 
        manner proportional to the award basis specified in section 
        1242(a)(2) to each eligible trauma center.
    ``(h) Report.--Beginning 2 years after the date of enactment of the 
Affordable Health Choices Act, and every 2 years thereafter, the 
Secretary shall biennially report to Congress regarding the status of 
the grants made under section 1241 and on the overall financial 
stability of trauma centers.''.
            (5) Authorization of appropriations.--Section 1245 of the 
        Public Health Service Act (42 U.S.C. 300d-45) is amended to 
        read as follows:

``SEC. 1245. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purpose of carrying out this part, there are authorized 
to be appropriated $100,000,000 for fiscal year 2009, and such sums as 
may be necessary for each of fiscal years 2010 through 2015. Such 
authorization of appropriations is in addition to any other 
authorization of appropriations or amounts that are available for such 
purpose.''.
            (6) Definition.--Part D of title XII of the Public Health 
        Service Act (42 U.S.C. 300d-41 et seq.) is amended by adding at 
        the end the following:

``SEC. 1246. DEFINITION.

    ``In this part, the term `uncompensated care costs' means 
unreimbursed costs from serving self-pay, charity, or Medicaid 
patients, without regard to payment under section 1923 of the Social 
Security Act, all of which are attributable to emergency care and 
trauma care, including costs related to subsequent inpatient admissions 
to the hospital.''.
    (b) Trauma Service Availability.--Title XII of the Public Health 
Service Act (42 U.S.C. 300d et seq.) is amended by adding at the end 
the following:

                 ``PART H--TRAUMA SERVICE AVAILABILITY

``SEC. 1281. GRANTS TO STATES.

    ``(a) Establishment.--To promote universal access to trauma care 
services provided by trauma centers and trauma-related physician 
specialties, the Secretary shall provide funding to States to enable 
such States to award grants to eligible entities for the purposes 
described in this section.
    ``(b) Awarding of Grants by States.--Each State may award grants to 
eligible entities within the State for the purposes described in 
subparagraph (d).
    ``(c) Eligibility.--
            ``(1) In general.--To be eligible to receive a grant under 
        subsection (b) an entity shall--
                    ``(A) be--
                            ``(i) a public or nonprofit trauma center 
                        or consortium thereof that meets that 
                        requirements of paragraphs (1), (2), and (5) of 
                        section 1241(b);
                            ``(ii) a safety net public or nonprofit 
                        trauma center that meets the requirements of 
                        paragraphs (1) through (5) of section 1241(b); 
                        or
                            ``(iii) a hospital in an underserved area 
                        (as defined by the State) that seeks to 
                        establish new trauma services; and
                    ``(B) submit to the State an application at such 
                time, in such manner, and containing such information 
                as the State may require.
            ``(2) Limitation.--A State shall use at least 40 percent of 
        the amount available to the State under this part for a fiscal 
        year to award grants to safety net trauma centers described in 
        paragraph (1)(A)(ii).
    ``(d) Use of Funds.--The recipient of a grant under subsection (b) 
shall carry out 1 or more of the following activities consistent with 
subsection (b):
            ``(1) Providing trauma centers with funding to support 
        physician compensation in trauma-related physician specialties 
        where shortages exist in the region involved, with priority 
        provided to safety net trauma centers described in subsection 
        (c)(1)(A)(ii).
            ``(2) Providing for individual safety net trauma center 
        fiscal stability and costs related to having service that is 
        available 24 hours a day, 7 days a week, with priority provided 
        to safety net trauma centers described in subsection 
        (c)(1)(A)(ii) located in urban, border, and rural areas.
            ``(3) Reducing trauma center overcrowding at specific 
        trauma centers related to throughput of trauma patients.
            ``(4) Establishing new trauma services in underserved areas 
        as defined by the State.
            ``(5) Enhancing collaboration between trauma centers and 
        other hospitals and emergency medical services personnel 
        related to trauma service availability.
            ``(6) Making capital improvements to enhance access and 
        expedite trauma care, including providing helipads and 
        associated safety infrastructure.
            ``(7) Enhancing trauma surge capacity at specific trauma 
        centers.
            ``(8) Ensuring expedient receipt of trauma patients 
        transported by ground or air to the appropriate trauma center.
            ``(9) Enhancing interstate trauma center collaboration.
    ``(e) Limitation.--
            ``(1) In general.--A State may use not more than 20 percent 
        of the amount available to the State under this part for a 
        fiscal year for administrative costs associated with awarding 
        grants and related costs.
            ``(2) Maintenance of effort.--The Secretary may not provide 
        funding to a State under this part unless the State agrees that 
        such funds will be used to supplement and not supplant State 
        funding otherwise available for the activities and costs 
        described in this part.
    ``(f) Distribution of Funds.--The following shall apply with 
respect to grants provided in this part:
            ``(1) Less than $10,000,000.--If the amount of 
        appropriations for this part in a fiscal year is less than 
        $10,000,000, the Secretary shall divide such funding evenly 
        among only those States that have 1 or more trauma centers 
        eligible for funding under section 1241(b)(3)(A).
            ``(2) Less than $20,000,000.--If the amount of 
        appropriations in a fiscal year is less than $20,000,000, the 
        Secretary shall divide such funding evenly among only those 
        States that have 1 or more trauma centers eligible for funding 
        under subparagraphs (A) and (B) of section 1241(b)(3).
            ``(3) Less than $30,000,000.--If the amount of 
        appropriations for this part in a fiscal year is less than 
        $30,000,000, the Secretary shall divide such funding evenly 
        among only those States that have 1 or more trauma centers 
        eligible for funding under section 1241(b)(3).
            ``(4) $30,000,000 or more.--If the amount of appropriations 
        for this part in a fiscal year is $30,000,000 or more, the 
        Secretary shall divide such funding evenly among all States.

``SEC. 1282. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purpose of carrying out this part, there is authorized to 
be appropriated $100,000,000 for each of fiscal years 2010 through 
2015.''.

SEC. 216. REDUCING AND REPORTING HOSPITAL READMISSIONS.

    (a) In General.--Part S of title III of the Public Health Service 
Act, as amended by section 205, is further amended by adding at the end 
the following:

``SEC. 399NN. READMISSIONS.

    ``(a) Purpose.--The purpose of this section is to improve the 
quality and value of inpatient hospital services in order to--
            ``(1) improve the coordination of care; and
            ``(2) appropriately reduce inefficiency and waste, such as 
        unnecessary hospital readmissions, in the care furnished.
    ``(b) Information Gathering and Analysis.--Beginning 2010, the 
Secretary shall analyze and calculate hospital-specific and national 
applicable readmissions rates based on subsection (e). In developing 
criteria and carrying out this section, the Secretary shall consider 
the unique characters of rural and low-volume hospitals (including 
critical access hospitals).
    ``(c) Disclosure.--
            ``(1) In general.--Beginning in 2011, the Secretary shall 
        establish procedures to provide for the confidential disclosure 
        to hospitals receiving funds under this Act of information on 
        hospital-specific and national applicable readmission rates 
        described in subsection (b).
            ``(2) Public disclosure of information.--Not later than 2 
        years after the date of enactment of this section, the 
        Secretary shall make the information on the rates of applicable 
        readmission rates and other statistical information of hospital 
        receiving funds under this Act disclosed under paragraph (1) 
        publicly available in a form and manner determined appropriate 
        by the Secretary.
            ``(3) Report.--Not later than 180 days after the date of 
        enactment of this section, the Secretary shall submit to 
        Congress a report that contains--
                    ``(A) a summary of the implementation of the 
                procedures under paragraph (1);
                    ``(B) a plan for the public disclosure of 
                information under paragraph (2); and
                    ``(C) recommendations for such legislation or 
                administrative action as the Secretary determines 
                appropriate.
    ``(d) Applicable Readmission Defined.--
            ``(1) In general.--In this section, the term `applicable 
        readmission' means a readmission--
                    ``(A) selected by the Secretary under subsection 
                (e));
                    ``(B) that occurs within a time interval (as 
                specified under subsection (f)) following a discharge 
                from a hospital; and
                    ``(C) which is for a condition or procedure 
                selected under subsection (g).
            ``(2) Determination of applicability to readmissions to 
        certain hospitals.--The Secretary shall determine whether the 
        term `applicable readmission' includes readmissions to the same 
        hospital as the prior discharge or readmissions to any 
        hospital.
    ``(e) Selection of Readmissions.--Not later 6 months after the date 
of enactment of this section, the Secretary, in consultation with 
appropriate representatives of the Centers for Medicare & Medicaid 
Services and the Agency for Healthcare Research and Quality, shall, for 
each of the conditions or procedures selected under subsection (g), 
select readmissions that meet each of the following requirements:
            ``(1) The readmission could reasonably have been prevented 
        by the provision of care consistent with evidence-based 
        guidelines during the prior admission or the post discharge 
        follow-up period.
            ``(2) The readmission is for a condition or procedure 
        related to the care provided during the prior admission or post 
        discharge follow-up period, which includes a readmission for 
        the following:
                    ``(A) The same condition or procedure as the prior 
                discharge.
                    ``(B) An infection or other complication of care.
                    ``(C) A condition or procedure indicative of a 
                failed surgical intervention.
                    ``(D) Other conditions or procedures as determined 
                appropriate by the Secretary.
    ``(f) Specification of Time Interval.--The Secretary shall specify 
a time interval, of not less than 7 days and not more than 30 days, 
between the prior discharge and applicable readmission for purposes of 
this section.
    ``(g) Selection of Conditions or Procedures.--
            ``(1) In general.--Not later than 6 months after the date 
        of enactment of this section, the Secretary shall select at 
        least 2 conditions or procedures which meet each of the 
        following requirements:
                    ``(A) Such conditions or procedures have a high 
                volume.
                    ``(B) For the time interval specified under 
                subsection (f), such conditions or procedures have a 
                relatively high rate of occurrence of subsequent 
                readmissions described in subsection (f), as compared 
                to all other conditions or procedures.
            ``(2) Expansion of conditions or procedures selected.--The 
        Secretary shall expand the list of readmission conditions 
        analyzed under this section to include at least 8 conditions 
        with the highest volume and highest rate of readmissions. At 
        least one of the conditions selected shall be a condition 
        prevalent in geriatric patients.
    ``(h) Quality Improvement Program for Hospitals With a High 
Severity Adjusted Readmission Rate.--
            ``(1) Establishment.--
                    ``(A) In general.--Not later than 2 years after the 
                date of enactment of this section, the Secretary shall 
                establish a program for eligible hospitals to improve 
                their readmission rates through the use of patient 
                safety organizations (as defined in section 921(4)).
                    ``(B) Eligible hospital defined.--In this 
                subsection, the term `eligible hospital' means a 
                hospital which the Secretary determines (based on the 
                most recent available historical data) has a severity 
                adjusted readmission rate for the conditions described 
                in subsection (g) among the highest 25 percent of all 
                hospitals nationally.
                    ``(C) Risk adjustment.--The Secretary shall utilize 
                appropriate risk adjustment measures to determine 
                eligible hospitals.
            ``(2) Report to the secretary.--Eligible hospitals and 
        patient safety organizations working with those hospitals shall 
        report to the Secretary on the processes employed by the 
        hospital to improve readmission rates and the impact of such 
        processes on readmission rates.''.
    (b) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study on the impact of section 399NN of the 
        Public Health Service Act, as added by subsection (a), on--
                    (A) care furnished to consumers;
                    (B) expenditures under Federal health programs; and
                    (C) the cost and quality of care furnished by 
                hospitals.
            (2) Report.--Not later than January 1, 2013, the 
        Comptroller General of the United States shall submit to 
        Congress a report on the study conducted under paragraph (1), 
        together with recommendations for such legislation and 
        administrative action as the Comptroller General determines 
        appropriate.
    (c) Study by IOM.--
            (1) In general.--The Secretary of Health and Human Services 
        shall seek to enter into an agreement with the Institute of 
        Medicine to submit to Congress, not later than 1 year after the 
        date of enactment of this Act, a report on recommendations on 
        how to reduce unnecessary hospital readmissions. Such report 
        shall also include recommendations on how to develop a 
        coordinated care plan for patients being discharged from the 
        hospital.
            (2) Authorization.--For the purpose of carrying out this 
        subsection, there is authorized to be appropriated such sums as 
        may be necessary for fiscal year 2010.

SEC. 217. PROGRAM TO FACILITATE SHARED DECISIONMAKING.

    Part D of title IX of the Public Health Service Act, as amended by 
section 213, is further amended by adding at the end the following:

``SEC. 936. PROGRAM TO FACILITATE SHARED DECISIONMAKING.

    ``(a) Purpose.--The purpose of this section is to facilitate 
collaborative processes between patients, caregivers or authorized 
representatives, and clinicians that engages the patient, caregiver or 
authorized representative in decisionmaking, provides patients, 
caregivers or authorized representatives with information about trade-
offs among treatment options, and facilitates the incorporation of 
patient preferences and values into the medical plan.
    ``(b) Definitions.--In this section:
            ``(1) Patient decision aid.--The term `patient decision 
        aid' means an educational tool that helps patients, caregivers 
        or authorized representatives understand and communicate their 
        beliefs and preferences related to their treatment options, and 
        to decide with their health care provider what treatments are 
        best for them based on their treatment options, scientific 
        evidence, circumstances, beliefs, and preferences.
            ``(2) Preference sensitive care.--The term `preference 
        sensitive care' means medical care for which the clinical 
        evidence does not clearly support one treatment option such 
        that the appropriate course of treatment depends on the values 
        of the patient or the preferences of the patient, caregivers or 
        authorized representatives regarding the benefits, harms and 
        scientific evidence for each treatment option, the use of such 
        care should depend on the informed patient choice among 
        clinically appropriate treatment options.
    ``(c) Establishment of Independent Standards for Patient Decision 
Aids for Preference Sensitive Care.--
            ``(1) Contract with entity to establish standards and 
        certify patient decision aids.--
                    ``(A) In general.--For purposes of supporting 
                consensus-based standards for patient decision aids for 
                preference sensitive care and a certification process 
                for patient decision aids for use in the Federal health 
                programs and by other interested parties, the Secretary 
                shall have in effect a contract with the qualified 
                consensus-based entity identified in section 399JJ. 
                Such contract shall provide that the entity perform the 
                duties described in paragraph (2).
                    ``(B) Timing for first contract.--As soon as 
                practicable after the date of the enactment of this 
                section, the Secretary shall enter into the first 
                contract under subparagraph (A).
                    ``(C) Period of contract.--A contract under 
                subparagraph (A) shall be for a period of 18 months 
                (except such contract may be renewed after a subsequent 
                bidding process).
            ``(2) Duties.--The following duties are described in this 
        paragraph:
                    ``(A) Develop and identify standards for patient 
                decision aids.--The entity shall synthesize evidence 
                and convene a broad range of experts and key 
                stakeholders to develop and identify consensus-based 
                standards to evaluate patient decision aids for 
                preference sensitive care.
                    ``(B) Endorse patient decision aids.--The entity 
                shall review patient decision aids and develop a 
                certification process whether patient decision aids 
                meet the standards developed and identified under 
                subparagraph (A). The entity shall give priority to the 
                review and certification of patient decision aids for 
                preference sensitive care.
    ``(d) Program to Develop, Update and Patient Decision Aids to 
Assist Health Care Providers and Patients.--
            ``(1) In general.--The Secretary, acting through the 
        Director, and in coordination with heads of other relevant 
        agencies, such as the Director of the Centers for Disease 
        Control and Prevention and the Director of the National 
        Institutes of Health, shall establish a program to award grants 
        or contracts--
                    ``(A) to develop, update, and produce patient 
                decision aids for preference sensitive care to assist 
                health care providers in educating patients, 
                caregivers, and authorized representatives concerning 
                the relative safety, relative effectiveness (including 
                possible health outcomes and impact on functional 
                status), and relative cost of treatment or, where 
                appropriate, palliative care options;
                    ``(B) to test such materials to ensure such 
                materials are balanced and evidence based in aiding 
                health care providers and patients, caregivers, and 
                authorized representatives to make informed decisions 
                about patient care and can be easily incorporated into 
                a broad array of practice settings; and
                    ``(C) to educate providers on the use of such 
                materials, including through academic curricula.
            ``(2) Requirements for patient decision aids.--Patient 
        decision aids developed and produced pursuant to a grant or 
        contract under paragraph (1)--
                    ``(A) shall be designed to engage patients, 
                caregivers, and authorized representatives in informed 
                decisionmaking with health care providers;
                    ``(B) shall present up-to-date clinical evidence 
                about the risks and benefits of treatment options in a 
                form and manner that is age-appropriate and can be 
                adapted for patients, caregivers, and authorized 
                representatives from a variety of cultural and 
                educational backgrounds to reflect the varying needs of 
                consumers and diverse levels of health literacy;
                    ``(C) shall, where appropriate, explain why there 
                is a lack of evidence to support one treatment option 
                over another; and
                    ``(D) shall address health care decisions across 
                the age span, including those affecting vulnerable 
                populations including children.
            ``(3) Distribution.--The Director shall ensure that patient 
        decision aids produced with grants or contracts under this 
        section are available to the public.
            ``(4) Nonduplication of efforts.--The Director shall ensure 
        that the activities under this section of the Agency and other 
        agencies, including the Centers for Disease Control and 
        Prevention and the National Institutes of Health, are free of 
        unnecessary duplication of effort.
    ``(e) Grants to Support Shared Decision Making Implementation.--
            ``(1) In general.--The Secretary shall establish a program 
        to provide for the phased-in development, implementation, and 
        evaluation of shared decisionmaking using patient decision aids 
        to meet the objective of improving the understanding of 
        patients of their medical treatment options.
            ``(2) Shared decisionmaking resource centers.--
                    ``(A) In general.--The Secretary shall provide 
                grants for the establishment and support of Shared 
                Decision Making Resource Centers (referred to in this 
                subsection as `Centers') to provide technical 
                assistance to providers and to develop and disseminate 
                best practices and other information to support and 
                accelerate adoption, implementation, and effective use 
                of patient decision aids and shared decision making by 
                providers.
                    ``(B) Objectives.--The objective of a Center is to 
                enhance and promote the adoption of patient decision 
                aids and shared decisionmaking through--
                            ``(i) providing assistance to eligible 
                        providers with the implementation and effective 
                        use of, and training on, patient decision aids; 
                        and
                            ``(ii) the dissemination of best practices 
                        and research on the implementation and 
                        effective use of patient decision aids.
            ``(3) Shared decisionmaking participation grants.--
                    ``(A) In general.--The Secretary shall provide 
                grants to health care providers for the development and 
                implementation of shared decisionmaking techniques.
                    ``(B) Preference.--In order to facilitate the use 
                of best practices, the Secretary shall provide a 
                preference in making grants under this subsection to 
                health care providers who participate in training by 
                Shared Decision Making Resource Centers or comparable 
                training.
                    ``(C) Limitation.--Funds under this paragraph shall 
                not be used to purchase or implement use of patient 
                decision aids other than those certified under the 
                process identified in subsection (c).
            ``(4) Guidance.--The Secretary may issue guidance to 
        eligible grantees under this subsection on the use of patient 
        decision aids.
            ``(5) Quality measures.--
                    ``(A) In general.--The Secretary shall measure the 
                quality of shared decisionmaking. For purposes of 
                making such measurements, the Secretary shall select 
                quality measures as described in section 399JJ.
                    ``(B) Reporting data on measures.--A provider 
                receiving a grant under this subsection shall report to 
                the Secretary data on quality measures selected under 
                subparagraph (A) in accordance with procedures 
                established by the Secretary.
                    ``(C) Feedback on measures.--The Secretary shall 
                provide confidential reports to eligible providers 
                receiving a grant under this section on the performance 
                of the eligible provider on quality measures selected 
                by the Secretary under subparagraph (A), the aggregate 
                performance of all eligible providers participating in 
                the program, and any improvements in such performance. 
                Such reports shall be made publicly available not less 
                than 3 years after the date of enactment of this 
                section.
                    ``(D) Grant to fund development of performance 
                measures.--The Director may, through the quality 
                measure development program under section 931, award 
                grants or contracts to eligible entities to fund 
                development of performance measures which assess the 
                use by health care providers of shared decisionmaking 
                processes or patient decision aids.
                    ``(E) Contents of report.--Each report submitted 
                under this paragraph shall--
                            ``(i) include an assessment of--
                                    ``(I) quality measures selected 
                                under subparagraph (A);
                                    ``(II) patient and health care 
                                provider satisfaction with regard to 
                                activities carried out under this 
                                paragraph;
                                    ``(III) utilization of medical 
                                services for patients of providers 
                                receiving a grant under this paragraph 
                                and other patients as determined 
                                appropriate by the Secretary;
                                    ``(IV) appropriate utilization of 
                                shared decisionmaking by providers 
                                receiving a grant under this paragraph; 
                                and
                                    ``(V) the costs to providers 
                                participating of selecting, purchasing, 
                                and incorporating approved patient 
                                decision aids and meeting reporting 
                                requirements under this paragraph; and
                            ``(ii) identify the characteristics of 
                        individual eligible providers that are most 
                        effective in implementing shared decisionmaking 
                        under the applicable phase of the program.
    ``(f) Funding.--For purposes of carrying out this section there are 
authorized to be appropriated such sums as may be necessary for fiscal 
year 2010 and each subsequent fiscal year.''.

SEC. 218. PRESENTATION OF PRESCRIPTION DRUG BENEFIT AND RISK 
              INFORMATION.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), acting through the 
Commissioner of Food and Drugs, shall determine whether the addition of 
quantitative summaries of the benefits and risks of prescription drugs 
in a standardized format (such as a table or drug facts box) to the 
promotional labeling or print advertising of such drugs would improve 
health care decisionmaking by clinicians and patients and consumers.
    (b) Review and Consultation.--In making the determination under 
subsection (a), the Secretary shall review all available scientific 
evidence and research on decisionmaking and social and cognitive 
psychology and consult with drug manufacturers, clinicians, patients 
and consumers, experts in health literacy, representatives of racial 
and ethnic minorities, and experts in women's and pediatric health.
    (c) Report.--Not later than 1 year after the date of enactment of 
this Act, the Secretary shall submit to Congress a report that 
provides--
            (1) the determination by the Secretary under subsection 
        (a); and
            (2) the reasoning and analysis underlying that 
        determination.
    (d) Authority.--If the Secretary determines under subsection (a) 
that the addition of quantitative summaries of the benefits and risks 
of prescription drugs in a standardized format (such as a table or drug 
facts box) to the promotional labeling or print advertising of such 
drugs would improve health care decision-making by clinicians and 
patients and consumers, then the Secretary, not later than 3 years 
after the date of submission of the report under subsection (c), shall 
promulgate proposed regulations as necessary to implement such format.
    (e) Clarification.--Nothing in this section shall be construed to 
restrict the existing authorities of the Secretary with respect to 
benefit and risk information.

SEC. 219. CENTER FOR HEALTH OUTCOMES RESEARCH AND EVALUATION.

    Part D of title IX of the Public Health Service Act, as amended by 
section 217, is further amended by adding at the end the following:

``SEC. 937. CENTER FOR HEALTH OUTCOMES RESEARCH AND EVALUATION.

    ``(a) Establishment.--The Secretary shall establish within the 
Agency the Center for Health Outcomes Research and Evaluation (referred 
to in this section as the `Center') to collect, conduct, support, and 
synthesize research with respect to comparing health outcomes, 
effectiveness, and appropriateness of health care services and 
procedures in order to identify the manner in which diseases, 
disorders, and other health conditions can most effectively and 
appropriately be prevented, diagnosed, treated, and managed clinically.
    ``(b) Duties.--The Center shall--
            ``(1) coordinate, conduct, support, and synthesize research 
        relevant to the comparative health outcomes and effectiveness 
        of the full spectrum of health care treatments, including 
        pharmaceuticals, medical devices, medical and surgical 
        procedures, screening and diagnostics, behavioral health care, 
        oral health, and other health interventions;
            ``(2) coordinate, conduct, and support systematic reviews 
        of clinical research, including original research conducted 
        subsequent to the date of the enactment of this section;
            ``(3) coordinate, conduct, support, and synthesize research 
        that--
                    ``(A) identifies which treatment is most effective 
                and least toxic for each individual given each 
                individual's genetic makeup and coexisting conditions; 
                and
                    ``(B) reduces treatment disparities, among ethnic 
                and racial minorities, children, and vulnerable 
                populations;
            ``(4) use a broad range of methodologies, including 
        randomized controlled clinical trials, observational studies 
        and other approaches;
            ``(5) create informational tools that organize, synthesize, 
        and disseminate research findings to providers, patients, and 
        public and private payers;
            ``(6) develop a publicly available resource database that 
        collects and contains high-quality, independent evidence to 
        inform healthcare decisionmaking, which shall include reliable 
        evidence from government and non-government sources;
            ``(7) submit to the Secretary, and Congress appropriate 
        relevant reports described in subsection (h);
            ``(8) encourage, as appropriate, the development and use of 
        clinical registries and the development of health outcomes 
        research data networks from electronic health records, post 
        marketing drug and medical device surveillance efforts, and 
        other forms of electronic health data; and
            ``(9) not later than one year after the date of the 
        enactment of this section, develop minimum methodological 
        standards to be used when conducting studies of comparative 
        health outcomes and value (and procedures for use of such 
        standards) in order to help ensure accurate and effective 
        comparisons and assessments of treatment options, and update 
        such standards at least biennially.
    ``(c) Powers.--
            ``(1) Obtaining official data.--The Center may secure 
        directly from any department or agency of the United States 
        information necessary to enable the Center to carry out this 
        section. Upon request of the Center, the head of that 
        department or agency shall furnish that information to the 
        Center on an agreed upon schedule.
            ``(2) Data collection.--In order to carry out its 
        functions, the Center shall--
                    ``(A) utilize existing information, both published 
                and unpublished, where possible, collected and assessed 
                either by the staff of the Center or under other 
                arrangements made in accordance with this section;
                    ``(B) carry out, or award grants or contracts for, 
                original research and experimentation, where existing 
                information is inadequate;
                    ``(C) adopt procedures allowing any interested 
                party to submit information for use by the Center or 
                the Advisory Counsel under subsection (d) in making 
                reports and recommendations; and
                    ``(D) comply with any existing data privacy 
                standards applicable to the Center.
            ``(3) Periodic audit.---The Center shall be subject to 
        periodic audit by the Comptroller General.
    ``(d) Advisory Council.--
            ``(1) In general.--To ensure transparency, the Secretary 
        shall establish through the Agency's National Advisory Council, 
        an advisory council (referred to in this section as the 
        `Council') that includes representatives from the scientific 
        research, patient, provider, and health industry communities.
            ``(2) Composition of council.--
                    ``(A) In general.--The members of the Council shall 
                consist of--
                            ``(i) 2 ex officio members who shall be--
                                    ``(I) the Director; and
                                    ``(II) the Chief Medical Officer of 
                                the Centers for Medicare & Medicaid 
                                Services; and
                            ``(ii) 19 additional members who shall 
                        represent broad constituencies of stakeholders.
                    ``(B) Qualifications.--
                            ``(i) Diverse representation of 
                        perspectives.--The members of the Council shall 
                        represent a broad range of perspectives and 
                        shall collectively have experience in the 
                        following areas:
                                    ``(I) Epidemiology.
                                    ``(II) Health services research.
                                    ``(III) Bioethics.
                                    ``(IV) Communication and decision 
                                sciences.
                                    ``(V) Health economics.
                                    ``(VI) Safe use of medical 
                                products.
                                    ``(VII) The practice of medicine.
                            ``(ii) Diverse representation of health 
                        care community.--At least one member shall 
                        represent each of the following health care 
                        communities:
                                    ``(I) Consumers.
                                    ``(II) Practicing physicians, 
                                including surgeons.
                                    ``(III) Nurses.
                                    ``(IV) State licensed practitioners 
                                and other health care professionals.
                                    ``(V) Employers.
                                    ``(VI) Public payers.
                                    ``(VII) Insurance plans.
                                    ``(VIII) Clinical researchers who 
                                conduct research on behalf of 
                                pharmaceutical or device manufacturers.
                                    ``(IX) Clinical researchers who 
                                conduct research related to 
                                personalized medicine.
                                    ``(X) Clinical researchers who 
                                conduct research related to reducing 
                                health disparities.
            ``(3) Appointment.--The Secretary or the Secretary's 
        designee shall appoint the members of the Council.
            ``(4) Terms.--
                    ``(A) In general.---Except as provided in 
                subparagraph (B), each member of the Council shall be 
                appointed for a term of 4 years.
                    ``(B) Terms of initial appointees.---Of the members 
                first appointed--
                            ``(i) 10 shall be appointed for a term of 4 
                        years; and
                            ``(ii) 9 shall be appointed for a term of 2 
                        years.
            ``(5) Conflicts of interest.---In appointing the members of 
        the Council, the Secretary shall take into consideration any 
        financial conflicts of interest.
    ``(e) Rare Disease Research.--In the case of a research study of a 
rare disease, the Secretary shall appoint a clinical expert advisory 
panel for purposes of assisting in the design of such research study 
and determining the feasibility of recruiting for and conducting such 
research study.
    ``(f) Expert Advisory Panels.--The Center may appoint expert 
advisory panels to advise the Center and the agency, instrumentality, 
or entity conducting the research regarding the research question 
involved and the research design or protocol, including important 
patient subgroups and other parameters of the research. Such expert 
advisory panels may include individuals with experience in the relevant 
topic, project, or category for which the panel is established, 
including practicing and research clinicians and relevant specialists 
and subspecialists.
    ``(g) Research Requirements.--Any research conducted, supported, or 
synthesized under this section shall meet the following requirements:
            ``(1) Ensuring transparency, credibility, and access.--The 
        establishment of the agenda and conduct of the research shall 
        be insulated from undue political or stakeholder influence, in 
        accordance with the following:
                    ``(A) Methods of conducting such research shall be 
                scientifically based and take into account scientific 
                advances in personalized medicine and reduces treatment 
                disparities that include ethnic and racial minorities 
                and children.
                    ``(B) All aspects of the prioritization of 
                research, conduct of the research, and development of 
                conclusions based on the research shall be transparent 
                to all stakeholders.
                    ``(C) The process and methods for conducting such 
                research shall be publicly documented and available to 
                all stakeholders.
                    ``(D) The Center shall establish a process for 
                stakeholders involved to review and provide comment on 
                the methods and findings of such research.
            ``(2) Stakeholder input.--The priorities of the research, 
        the research, and the dissemination of the research shall 
        involve the consultation of patients, health care providers, 
        experts in wellness and health promotion, and health care 
        consumer representatives through transparent mechanisms 
        recommended by the Council.
    ``(h) Public Access to Health Outcomes Information.--
            ``(1) In general.--To the extent practicable, not later 
        than 180 days after receipt by the Center of a relevant report 
        described in paragraph (2), appropriate information contained 
        in such report shall be posted on the official public Internet 
        site of the Center, as applicable.
            ``(2) Relevant reports described.--For purposes of this 
        section, a relevant report is each of the following submitted 
        by a grantee or contractor of the Center:
                    ``(A) An interim progress report.
                    ``(B) A draft final report that is available to 
                stakeholders for review.
                    ``(C) Stakeholder comments and response to same.
                    ``(D) A final progress report on new research 
                submitted for publication by a peer review journal.
                    ``(E) A final report.
            ``(3) Benefit to subpopulations.--All reports described in 
        paragraph (2) shall assess whether the research demonstrates a 
        benefit of the therapy with respect to a specific subpopulation 
        of individuals, even if the outcome of the research 
        demonstrates that, on average, with respect to the general 
        population, the clinical benefits of the treatment do not 
        exceed the harm.
    ``(i) Access by Congress and the Counsel to Center Information.--
The Secretary shall establish a process for the Center to share with 
Congress reports and non-proprietary data of the Center.
    ``(j) Dissemination, Incorporation, and Feedback of Information.--
            ``(1) Dissemination.--The Center shall provide for the 
        dissemination of findings produced by research supported, 
        conducted, or synthesized under this section to health care 
        providers, patients, vendors of health information technology 
        focused on clinical decision support, appropriate professional 
        associations, and Federal and private health plans. Center 
        reports and recommendations shall not be construed as mandates 
        for payment, coverage, or treatment.
            ``(2) Incorporation.--The Center shall assist users of 
        health information technology focused on clinical decision 
        support to promote the timely incorporation of the findings 
        described in paragraph (1) into clinical practices and to 
        promote the ease of use of such incorporation.
            ``(3) Feedback.--The Center shall establish a process to 
        receive feedback from providers, patients, vendors of health 
        information technology focused on clinical decision support, 
        appropriate professional associations, and Federal and private 
        health plans about the value of the information disseminated 
        under this section.
    ``(k) Reports to Congress.--
            ``(1) Annual reports.--Beginning not later than one year 
        after the date of enactment of this section, the Director shall 
        submit to Congress an annual report on the activities of the 
        Center and the Council, and the research conducted, under this 
        section.
            ``(2) Analysis and review.--Not later than December 31, 
        2011, the Secretary, shall submit to Congress a report on all 
        activities conducted or supported under this section as of such 
        date. Such report shall--
                    ``(A) include an evaluation of the impact from such 
                activities, the overall costs of such activities, and 
                an analysis of the backlog of any research proposals 
                approved but not funded; and
                    ``(B) address whether Congress should expand the 
                responsibilities of the Center to include studies of 
                the effectiveness of various aspects of the health care 
                delivery system, including health plans and delivery 
                models, such as health plan features, benefit designs 
                and performance, and the ways in which health services 
                are organized, managed, and delivered.''.

SEC. 220. DEMONSTRATION PROGRAM TO INTEGRATE QUALITY IMPROVEMENT AND 
              PATIENT SAFETY TRAINING INTO CLINICAL EDUCATION OF HEALTH 
              PROFESSIONALS.

    (a) In General.--The Secretary may award grants to eligible 
entities or consortia under this section to carry out demonstration 
projects to develop and implement academic curricula that integrates 
quality improvement and patient safety in the clinical education of 
health professionals. Such awards shall be made on a competitive basis 
and pursuant to peer review.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity or consortium shall--
            (1) submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary 
        may require;
            (2) be or include--
                    (A) a health professions school;
                    (B) a school of public health;
                    (C) a school of social work;
                    (D) a school of nursing;
                    (E) a school of pharmacy;
                    (F) an institution with a graduate medical 
                education program; or
                    (G) a school of health care administration;
            (3) collaborate in the development of curricula described 
        in subsection (a) with an organization that accredits such 
        school or institution;
            (4) provide for the collection of data regarding the 
        effectiveness of the demonstration project; and
            (5) provide matching funds in accordance with subsection 
        (c).
    (c) Matching Funds.--
            (1) In general.--The Secretary may award a grant to an 
        entity or consortium under this section only if the entity or 
        consortium agrees to make available non-Federal contributions 
        toward the costs of the program to be funded under the grant in 
        an amount that is not less than $1 for each $5 of Federal funds 
        provided under the grant.
            (2) Determination of amount contributed.--Non-Federal 
        contributions under paragraph (1) may be in cash or in kind, 
        fairly evaluated, including equipment or services. Amounts 
        provided by the Federal Government, or services assisted or 
        subsidized to any significant extent by the Federal Government, 
        may not be included in determining the amount of such 
        contributions.
    (d) Evaluation.--The Secretary shall take such action as may be 
necessary to evaluate the projects funded under this section and 
publish, make publicly available, and disseminate the results of such 
evaluations on as wide a basis as is practicable.
    (e) Reports.--Not later than 2 years after the date of enactment of 
this section, and annually thereafter, the Secretary shall submit to 
the Committee on Health, Education, Labor, and Pensions and the 
Committee on Finance of the Senate and the Committee on Energy and 
Commerce and the Committee on Ways and Means of the House of 
Representatives a report that--
            (1) describes the specific projects supported under this 
        section; and
            (2) contains recommendations for Congress based on the 
        evaluation conducted under subsection (d).

SEC. 221. OFFICE OF WOMEN'S HEALTH.

    (a) Health and Human Services Office on Women's Health.--
            (1) Establishment.--Part A of title II of the Public Health 
        Service Act (42 U.S.C. 202 et seq.) is amended by adding at the 
        end the following:

``SEC. 229. HEALTH AND HUMAN SERVICES OFFICE ON WOMEN'S HEALTH.

    ``(a) Establishment of Office.--There is established within the 
Office of the Secretary, an Office on Women's Health (referred to in 
this section as the `Office'). The Office shall be headed by a Deputy 
Assistant Secretary for Women's Health who may report to the Secretary.
    ``(b) Duties.--The Secretary, acting through the Office, with 
respect to the health concerns of women, shall--
            ``(1) establish short-range and long-range goals and 
        objectives within the Department of Health and Human Services 
        and, as relevant and appropriate, coordinate with other 
        appropriate offices on activities within the Department that 
        relate to disease prevention, health promotion, service 
        delivery, research, and public and health care professional 
        education, for issues of particular concern to women throughout 
        their lifespan;
            ``(2) provide expert advice and consultation to the 
        Secretary concerning scientific, legal, ethical, and policy 
        issues relating to women's health;
            ``(3) monitor the Department of Health and Human Services' 
        offices, agencies, and regional activities regarding women's 
        health and identify needs regarding the coordination of 
        activities, including intramural and extramural 
        multidisciplinary activities;
            ``(4) establish a Department of Health and Human Services 
        Coordinating Committee on Women's Health, which shall be 
        chaired by the Deputy Assistant Secretary for Women's Health 
        and composed of senior level representatives from each of the 
        agencies and offices of the Department of Health and Human 
        Services;
            ``(5) establish a National Women's Health Information 
        Center to--
                    ``(A) facilitate the exchange of information 
                regarding matters relating to health information, 
                health promotion, preventive health services, research 
                advances, and education in the appropriate use of 
                health care;
                    ``(B) facilitate access to such information;
                    ``(C) assist in the analysis of issues and problems 
                relating to the matters described in this paragraph; 
                and
                    ``(D) provide technical assistance with respect to 
                the exchange of information (including facilitating the 
                development of materials for such technical 
                assistance);
            ``(6) coordinate efforts to promote women's health programs 
        and policies with the private sector; and
            ``(7) through publications and any other means appropriate, 
        provide for the exchange of information between the Office and 
        recipients of grants, contracts, and agreements under 
        subsection (c), and between the Office and health professionals 
        and the general public.
    ``(c) Grants and Contracts Regarding Duties.--
            ``(1) Authority.--In carrying out subsection (b), the 
        Secretary may make grants to, and enter into cooperative 
        agreements, contracts, and interagency agreements with, public 
        and private entities, agencies, and organizations.
            ``(2) Evaluation and dissemination.--The Secretary shall 
        directly or through contracts with public and private entities, 
        agencies, and organizations, provide for evaluations of 
        projects carried out with financial assistance provided under 
        paragraph (1) and for the dissemination of information 
        developed as a result of such projects.
    ``(d) Reports.--Not later than 1 year after the date of enactment 
of this section, and every second year thereafter, the Secretary shall 
prepare and submit to the appropriate committees of Congress a report 
describing the activities carried out under this section during the 
period for which the report is being prepared.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2010 through 2014.''.
            (2) Transfer of functions.--There are transferred to the 
        Office on Women's Health (established under section 229 of the 
        Public Health Service Act, as added by this section), all 
        functions exercised by the Office on Women's Health of the 
        Public Health Service prior to the date of enactment of this 
        section, including all personnel and compensation authority, 
        all delegation and assignment authority, and all remaining 
        appropriations. All orders, determinations, rules, regulations, 
        permits, agreements, grants, contracts, certificates, licenses, 
        registrations, privileges, and other administrative actions 
        that--
                    (A) have been issued, made, granted, or allowed to 
                become effective by the President, any Federal agency 
                or official thereof, or by a court of competent 
                jurisdiction, in the performance of functions 
                transferred under this paragraph; and
                    (B) are in effect at the time this section takes 
                effect, or were final before the date of enactment of 
                this section and are to become effective on or after 
                such date,
        shall continue in effect according to their terms until 
        modified, terminated, superseded, set aside, or revoked in 
        accordance with law by the President, the Secretary, or other 
        authorized official, a court of competent jurisdiction, or by 
        operation of law.
    (b) Centers for Disease Control and Prevention Office of Women's 
Health.--Part A of title III of the Public Health Service Act (42 
U.S.C. 241 et seq.) is amended by adding at the end the following:

``SEC. 310A. CENTERS FOR DISEASE CONTROL AND PREVENTION OFFICE OF 
              WOMEN'S HEALTH.

    ``(a) Establishment.--There is established within the Office of the 
Director of the Centers for Disease Control and Prevention, an office 
to be known as the Office of Women's Health (referred to in this 
section as the `Office'). The Office shall be headed by a director who 
shall be appointed by the Director of such Centers.
    ``(b) Purpose.--The Director of the Office shall--
            ``(1) report to the Director of the Centers for Disease 
        Control and Prevention on the current level of the Centers' 
        activity regarding women's health conditions across, where 
        appropriate, age, biological, and sociocultural contexts, in 
        all aspects of the Centers' work, including prevention 
        programs, public and professional education, services, and 
        treatment;
            ``(2) establish short-range and long-range goals and 
        objectives within the Centers for women's health and, as 
        relevant and appropriate, coordinate with other appropriate 
        offices on activities within the Centers that relate to 
        prevention, research, education and training, service delivery, 
        and policy development, for issues of particular concern to 
        women;
            ``(3) identify projects in women's health that should be 
        conducted or supported by the Centers;
            ``(4) consult with health professionals, nongovernmental 
        organizations, consumer organizations, women's health 
        professionals, and other individuals and groups, as 
        appropriate, on the policy of the Centers with regard to women; 
        and
            ``(5) serve as a member of the Department of Health and 
        Human Services Coordinating Committee on Women's Health 
        (established under section 229(b)(4)).
    ``(c) Definition.--As used in this section, the term `women's 
health conditions', with respect to women of all age, ethnic, and 
racial groups, means diseases, disorders, and conditions--
            ``(1) unique to, significantly more serious for, or 
        significantly more prevalent in women; and
            ``(2) for which the factors of medical risk or type of 
        medical intervention are different for women, or for which 
        there is reasonable evidence that indicates that such factors 
        or types may be different for women.
    ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2010 through 2014.''.
    (c) Office of Women's Health Research.--Section 486(a) of the 
Public Health Service Act (42 U.S.C. 287d(a)) is amended by inserting 
``and who shall report directly to the Director'' before the period at 
the end thereof .
    (d) Substance Abuse and Mental Health Services Administration.--
Section 501(f) of the Public Health Service Act (42 U.S.C. 290aa(f)) is 
amended--
            (1) in paragraph (1), by inserting ``who shall report 
        directly to the Administrator'' before the period;
            (2) by redesignating paragraph (4) as paragraph (5); and
            (3) by inserting after paragraph (3), the following:
            ``(4) Office.--Nothing in this subsection shall be 
        construed to preclude the Secretary from establishing within 
        the Substance Abuse and Mental Health Administration an Office 
        of Women's Health.''.
    (e) Agency for Healthcare Research and Quality Activities Regarding 
Women's Health..--Part C of title IX of the Public Health Service Act 
(42 U.S.C. 299c et seq.) is amended--
            (1) by redesignating sections 925 and 926 as sections 926 
        and 927, respectively; and
            (2) by inserting after section 924 the following:

``SEC. 925. ACTIVITIES REGARDING WOMEN'S HEALTH.

    ``(a) Establishment.--There is established within the Office of the 
Director, an Office of Women's Health and Gender-Based Research 
(referred to in this section as the `Office'). The Office shall be 
headed by a director who shall be appointed by the Director of 
Healthcare and Research Quality.
    ``(b) Purpose.--The official designated under subsection (a) 
shall--
            ``(1) report to the Director on the current Agency level of 
        activity regarding women's health, across, where appropriate, 
        age, biological, and sociocultural contexts, in all aspects of 
        Agency work, including the development of evidence reports and 
        clinical practice protocols and the conduct of research into 
        patient outcomes, delivery of health care services, quality of 
        care, and access to health care;
            ``(2) establish short-range and long-range goals and 
        objectives within the Agency for research important to women's 
        health and, as relevant and appropriate, coordinate with other 
        appropriate offices on activities within the Agency that relate 
        to health services and medical effectiveness research, for 
        issues of particular concern to women;
            ``(3) identify projects in women's health that should be 
        conducted or supported by the Agency;
            ``(4) consult with health professionals, nongovernmental 
        organizations, consumer organizations, women's health 
        professionals, and other individuals and groups, as 
        appropriate, on Agency policy with regard to women; and
            ``(5) serve as a member of the Department of Health and 
        Human Services Coordinating Committee on Women's Health 
        (established under section 229(b)(4)).''.
    ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2010 through 2014.''.
    (f) Health Resources and Services Administration Office of Women's 
Health.--Title VII of the Social Security Act (42 U.S.C. 901 et seq.) 
is amended by adding at the end the following:

``SEC. 713. OFFICE OF WOMEN'S HEALTH.

    ``(a) Establishment.--The Secretary shall establish within the 
Office of the Administrator of the Health Resources and Services 
Administration, an office to be known as the Office of Women's Health. 
The Office shall be headed by a director who shall be appointed by the 
Administrator.
    ``(b) Purpose.--The Director of the Office shall--
            ``(1) report to the Administrator on the current 
        Administration level of activity regarding women's health 
        across, where appropriate, age, biological, and sociocultural 
        contexts;
            ``(2) establish short-range and long-range goals and 
        objectives within the Health Resources and Services 
        Administration for women's health and, as relevant and 
        appropriate, coordinate with other appropriate offices on 
        activities within the Administration that relate to health care 
        provider training, health service delivery, research, and 
        demonstration projects, for issues of particular concern to 
        women;
            ``(3) identify projects in women's health that should be 
        conducted or supported by the bureaus of the Administration;
            ``(4) consult with health professionals, nongovernmental 
        organizations, consumer organizations, women's health 
        professionals, and other individuals and groups, as 
        appropriate, on Administration policy with regard to women; and
            ``(5) serve as a member of the Department of Health and 
        Human Services Coordinating Committee on Women's Health 
        (established under section 229(b)(4) of the Public Health 
        Service Act).
    ``(c) Continued Administration of Existing Programs.--The Director 
of the Office shall assume the authority for the development, 
implementation, administration, and evaluation any projects carried out 
through the Health Resources and Services Administration relating to 
women's health on the date of enactment of this section.
    ``(d) Definitions.--For purposes of this section:
            ``(1) Administration.--The term `Administration' means the 
        Health Resources and Services Administration.
            ``(2) Administrator.--The term `Administrator' means the 
        Administrator of the Health Resources and Services 
        Administration.
            ``(3) Office.--The term `Office' means the Office of 
        Women's Health established under this section in the 
        Administration.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2010 through 2014.''.
    (g) Food and Drug Administration Office of Women's Health.--Chapter 
X of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 391 et seq.) 
is amended by adding at the end the following:

``SEC. 1011. OFFICE OF WOMEN'S HEALTH.

    ``(a) Establishment.--There is established within the Office of the 
Commissioner, an office to be known as the Office of Women's Health 
(referred to in this section as the `Office'). The Office shall be 
headed by a director who shall be appointed by the Commissioner of Food 
and Drugs.
    ``(b) Purpose.--The Director of the Office shall--
            ``(1) report to the Commissioner of Food and Drugs on 
        current Food and Drug Administration (referred to in this 
        section as the `Administration') levels of activity regarding 
        women's participation in clinical trials and the analysis of 
        data by sex in the testing of drugs, medical devices, and 
        biological products across, where appropriate, age, biological, 
        and sociocultural contexts;
            ``(2) establish short-range and long-range goals and 
        objectives within the Administration for issues of particular 
        concern to women's health within the jurisdiction of the 
        Administration, including, where relevant and appropriate, 
        adequate inclusion of women and analysis of data by sex in 
        Administration protocols and policies;
            ``(3) provide information to women and health care 
        providers on those areas in which differences between men and 
        women exist;
            ``(4) consult with pharmaceutical, biologics, and device 
        manufacturers, health professionals with expertise in women's 
        issues, consumer organizations, and women's health 
        professionals on Administration policy with regard to women;
            ``(5) make annual estimates of funds needed to monitor 
        clinical trials and analysis of data by sex in accordance with 
        needs that are identified; and
            ``(6) serve as a member of the Department of Health and 
        Human Services Coordinating Committee on Women's Health 
        (established under section 229(b)(4) of the Public Health 
        Service Act).
    ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2010 through 2014.''.
    (h) No New Regulatory Authority.--Nothing in this section and the 
amendments made by this section may be construed as establishing 
regulatory authority or modifying any existing regulatory authority.
    (i) Limitation on Termination.--Notwithstanding any other provision 
of law, a Federal office of women's health (including the Office of 
Research on Women's Health of the National Institutes of Health) or 
Federal appointive position with primary responsibility over women's 
health issues (including the Associate Administrator for Women's 
Services under the Substance Abuse and Mental Health Services 
Administration) that is in existence on the date of enactment of this 
section shall not be terminated, reorganized, or have any of it's 
powers or duties transferred unless such termination, reorganization, 
or transfer is approved by Congress through the adoption of a 
concurrent resolution of approval.
    (j) Rule of Construction.--Nothing in this section (or the 
amendments made by this section) shall be construed to limit the 
authority of the Secretary of Health and Human Services with respect to 
women's health, or with respect to activities carried out through the 
Department of Health and Human Services on the date of enactment of 
this section.

SEC. 222. ADMINISTRATIVE SIMPLIFICATION.

    (a) Standards for Financial and Administrative Transactions.--
            (1) In general.--The Secretary shall adopt and regularly 
        update standards, implementation specifications, and operating 
        rules for the electronic exchange and use of health information 
        for purposes of financial and administrative transactions (as 
        provided for in paragraph (2)).
            (2) Additional requirements for financial and 
        administrative transactions.--The standards, implementation 
        specifications, and operating rules provided for in paragraph 
        (1) shall--
                    (A) be unique with no conflicting or redundant 
                standards;
                    (B) be authoritative, requiring no additional 
                standards or companion guides;
                    (C) be comprehensive and robust, requiring minimal 
                augmentation by paper transactions or clarification by 
                phone calls;
                    (D) enable the real time determination of a 
                patient's financial responsibility at the point of 
                service and, to the extent possible, prior to service, 
                including whether a patient is eligible for a specific 
                service with a specific physician at a specific 
                facility, which may include a machine-readable health 
                plan identification card;
                    (E) provide for timely acknowledgment; and
                    (F) require that all data elements within a 
                standard or specification (such as reason and remark 
                codes) be described in unambiguous terms (with no 
                optional fields permitted and a requirement that data 
                elements be either required or conditioned upon set 
                values in other fields) with additional conditions 
                being prohibited.
            (3) Time for adoption.--Not later than 2 years after the 
        date of enactment of this section, the Secretary shall adopt 
        standards, implementation specifications, and operating rules 
        under this section.
            (4) Requirements for initial standards.--The initial set of 
        standards, implementation specifications, and operating rules 
        under paragraph (1) shall include--
                    (A) requirements to clarify, refine, and expand, as 
                needed, standards required under section 1173 of the 
                Social Security Act;
                    (B) requirements for acknowledgments, such as those 
                for receipt of a claim;
                    (C) requirements to permit electronic funds 
                transfers (to allow automated reconciliation with the 
                related health care payment and remittance advice);
                    (D) the requirements of timely and transparent 
                claim and denial management processes, including 
                tracking, adjudication, and appeal processing (for all 
                participants, including health insurance issuers, 
                health care providers, and patients); and
                    (E) other requirements relating to administrative 
                simplification as identified by the Secretary, in 
                consultation with stakeholders.
            (5) Building on existing standards.--In developing the 
        standards, implementation specifications, and operating rules 
        under paragraph (1), the Secretary shall build upon existing 
        and planned standards, implementation specifications, and 
        operating rules.
            (6) Expedited procedures for adoption of additions and 
        modifications to standards.--Notwithstanding any other 
        provision of law, the Secretary may use the following expedited 
        procedures for purposes of paragraph (1):
                    (A) Expedited upgrade program.--The Secretary shall 
                provide for an expedited upgrade program (in this 
                paragraph referred to as the ``upgrade program''), in 
                accordance with this paragraph, to develop and approve 
                additions and modifications to the standards described 
                in paragraph (4) to improve the quality of such 
                standards or to extend the functionality of such 
                standards to meet evolving requirements in health care.
                    (B) Publication of notices.--Under the upgrade 
                program:
                            (i) Voluntary notice of initiation of 
                        process.--Not later than 30 days after the date 
                        the Secretary receives a notice from a standard 
                        setting organization that the organization is 
                        initiating a process to develop an addition or 
                        modification to a standard described in 
                        paragraph (4), the Secretary shall publish a 
                        notice in the Federal Register that--
                                    (I) identifies the subject matter 
                                of the addition or modification;
                                    (II) provides a description of how 
                                persons may participate in the 
                                development process; and
                                    (III) invites public participation 
                                in such process.
                            (ii) Voluntary notice of preliminary draft 
                        of additions or modifications to standards.--
                        Not later than 30 days after the date the 
                        Secretary receives a notice from a standard 
                        setting organization that the organization has 
                        prepared a preliminary draft of an addition or 
                        modification to a standard described in 
                        paragraph (4), the Secretary shall publish a 
                        notice in the Federal Register that--
                                    (I) identifies the subject matter 
                                of (and summarizes) the addition or 
                                modification;
                                    (II) specifies the procedure for 
                                obtaining the draft;
                                    (III) provides a description of how 
                                persons may submit comments in writing 
                                and at any public hearing or meeting 
                                held by the organization on the 
                                addition or modification; and
                                    (IV) invites submission of such 
                                comments and participation in such 
                                hearing or meeting without requiring 
                                the public to pay a fee to participate.
                            (iii) Notice of proposed addition or 
                        modification to standards.--Not later than 30 
                        days after the date the Secretary receives a 
                        notice from a standard setting organization 
                        that the organization has a proposed addition 
                        or modification to a standard described in 
                        paragraph (4) that the organization intends to 
                        submit under subparagraph (D)(iii), the 
                        Secretary shall publish a notice in the Federal 
                        Register that contains, with respect to the 
                        proposed addition or modification, the 
                        information required in the notice under clause 
                        (ii) with respect to the addition or 
                        modification.
                            (iv) Construction.--Nothing in this 
                        paragraph shall be construed as requiring a 
                        standard setting organization to request the 
                        notices described in clauses (i) and (ii) with 
                        respect to an addition or modification to a 
                        standard in order to qualify for an expedited 
                        determination under subparagraph (C) with 
                        respect to a proposal submitted to the 
                        Secretary for adoption of such addition or 
                        modification.
                    (C) Provision of expedited determination.--Under 
                the upgrade program and with respect to a proposal by a 
                standard setting organization for an addition or 
                modification to a standard described in paragraph (4), 
                if the Secretary determines that the standard setting 
                organization developed such addition or modification in 
                accordance with the requirements of subparagraph (D) 
                and the National Committee on Vital and Health 
                Statistics recommends approval of such addition or 
                modification under subparagraph (E), the Secretary 
                shall provide for expedited treatment of such proposal 
                in accordance with subparagraph (F).
                    (D) Requirements.--The requirements under this 
                subparagraph with respect to a proposed addition or 
                modification to a standard by a standard setting 
                organization are the following:
                            (i) Request for publication of notice.--The 
                        standard setting organization submits to the 
                        Secretary a request for publication in the 
                        Federal Register of a notice described in 
                        subparagraph (B)(iii) for the proposed addition 
                        or modification.
                            (ii) Process for receipt and consideration 
                        of public comment.--The standard setting 
                        organization provides for a process through 
                        which, after the publication of the notice 
                        referred to under clause (i), the 
                        organization--
                                    (I) receives and responds to public 
                                comments submitted on a timely basis on 
                                the proposed addition or modification 
                                before submitting such proposed 
                                addition or modification to the 
                                National Committee on Vital and Health 
                                Statistics under clause (iii);
                                    (II) makes publicly available a 
                                written explanation for its response in 
                                the proposed addition or modification 
                                to comments submitted on a timely 
                                basis; and
                                    (III) makes public comments 
                                received under clause (I) available, or 
                                provides access to such comments, to 
                                the Secretary.
                            (iii) Submittal of final proposed addition 
                        or modification to ncvhs.--After completion of 
                        the process under clause (ii), the standard 
                        setting organization submits the proposed 
                        addition or modification to the National 
                        Committee on Vital and Health Statistics for 
                        review and consideration under subparagraph 
                        (E). Such submission shall include information 
                        on the organization's compliance with the 
                        notice and comment requirements (and responses 
                        to those comments) under clause (ii).
                    (E) Hearings and recommendations by national 
                committee on vital and health statistics.--Under the 
                upgrade program, upon receipt of a proposal submitted 
                by a standard setting organization under subparagraph 
                (D)(iii) for the adoption of an addition or 
                modification to a standard, the National Committee on 
                Vital and Health Statistics shall provide notice to the 
                public and a reasonable opportunity for public 
                testimony at a hearing on such addition or 
                modification. The Secretary may participate in such 
                hearing in such capacity (including presiding ex 
                officio) as the Secretary shall determine appropriate. 
                Not later than 120 days after the date of receipt of 
                the proposal, the Committee shall submit to the 
                Secretary its recommendation to adopt (or not adopt) 
                the proposed addition or modification.
                    (F) Determination by secretary to accept or reject 
                national committee on vital and health statistics 
                recommendation.--
                            (i) Timely determination.--Under the 
                        upgrade program, if the National Committee on 
                        Vital and Health Statistics submits to the 
                        Secretary a recommendation under subparagraph 
                        (E) to adopt a proposed addition or 
                        modification, not later than 90 days after the 
                        date of receipt of such recommendation the 
                        Secretary shall make a determination to accept 
                        or reject the recommendation and shall publish 
                        notice of such determination in the Federal 
                        Register not later than 90 days after the date 
                        of the determination.
                            (ii) Contents of notice.--If the 
                        determination is to reject the recommendation, 
                        such notice shall include the reasons for the 
                        rejection. If the determination is to accept 
                        the recommendation, as part of such notice the 
                        Secretary shall promulgate the modified 
                        standard (including the accepted proposed 
                        addition or modification accepted) as a final 
                        rule under this subsection without any further 
                        notice or public comment period.
                            (iii) Limitation on consideration.--The 
                        Secretary shall not consider a proposal under 
                        this subparagraph unless the Secretary 
                        determines that the requirements of 
                        subparagraph (D) (including publication of 
                        notice and opportunity for public comment) have 
                        been met with respect to the proposal.
                    (G) Exemption from paperwork reduction act.--
                Chapter 35 of title 44, United States Code, shall not 
                apply to a final rule promulgated under subparagraph 
                (F).
                    (H) Treatment as satisfying requirements for notice 
                and comment.--Any requirements under section 553 of 
                title 5, United States Code, relating to notice and an 
                opportunity for public comment with respect to a final 
                rule promulgated under subparagraph (F) shall be 
                treated as having been met by meeting the requirements 
                of the notice and opportunity for public comment 
                provided under provisions of subparagraphs (B)(iii), 
                (D), and (E).
                    (I) Modification defined.--For purposes of this 
                section, the term ``modification'' includes a new 
                version or a version upgrade.
            (7) Implementation and enforcement.--Not later than 2 years 
        after the date of enactment of this section, the Secretary 
        shall submit to the appropriate committees of Congress a plan 
        for the implementation and enforcement, by not later than 5 
        years after such date of enactment, of the standards, 
        implementation specifications, and operating rules provided for 
        under paragraph (1).
    (b) Health Plan Identifier.--Not later than 1 year after the date 
of enactment of this section, the Secretary shall promulgate a final 
rule to establish a National Health Plan Identifier system.

SEC. 223. PATIENT NAVIGATOR PROGRAM.

    Section 340A of the Public Health Service Act (42 U.S.C. 256a) is 
amended--
            (1) in subsection (e), by adding at the end the following:
            ``(3) Minimum core proficiencies.--The Secretary shall not 
        award a grant to an entity under this section unless such 
        entity provides assurances that patient navigators recruited, 
        assigned, trained, or employed using grant funds meet minimum 
        core proficiencies, as defined by the entity that submits the 
        application, that are tailored for the main focus or 
        intervention of the navigator involved.''; and
            (2) in subsection (m)--
                    (A) in paragraph (1), by striking ``and $3,500,000 
                for fiscal year 2010.'' and inserting ``$3,500,000 for 
                fiscal year 2010, and such sums as may be necessary for 
                each of fiscal years 2011 through 2015.''; and
                    (B) in paragraph (2), by striking ``2010'' and 
                inserting ``2015''.

SEC. 224. AUTHORIZATION OF APPROPRIATIONS.

    Except where otherwise provided in this subtitle (or an amendment 
made by this subtitle), there is authorized to be appropriated such 
sums as may be necessary to carry out this subtitle (and such 
amendments made by this subtitle).

  Subtitle C--Civil and Criminal Penalties for Acts Involving Federal 
  Health Care Programs; Exception to Limitation on Certain Physician 
                               Referrals

SEC. 231. SAFE HARBORS TO ANTIKICKBACK CIVIL PENALTIES AND CRIMINAL 
              PENALTIES FOR PROVISION OF HEALTH INFORMATION TECHNOLOGY 
              AND TRAINING SERVICES.

    (a) For Civil Penalties.--Section 1128A of the Social Security Act 
(42 U.S.C. 1320a-7a) is amended--
            (1) in subsection (b), by adding at the end the following 
        new paragraph:
    ``(4) For purposes of this subsection, inducements to reduce or 
limit services described in paragraph (1) shall not include the 
practical or other advantages resulting from health information 
technology or related installation, maintenance, support, or training 
services.''; and
            (2) in subsection (i), by adding at the end the following 
        new paragraph:
            ``(8) The term `health information technology' means 
        hardware, software, license, right, intellectual property, 
        equipment, or other information technology (including new 
        versions, upgrades, and connectivity) designed or provided 
        primarily for the electronic creation, maintenance, or exchange 
        of health information to better coordinate care or improve 
        health care quality, efficiency, or research.''.
    (b) For Criminal Penalties.--Section 1128B of such Act (42 U.S.C. 
1320a-7b) is amended--
            (1) in subsection (b)(3)--
                    (A) in subparagraph (G), by striking ``and'' at the 
                end;
                    (B) in the subparagraph (H) added by section 237(d) 
                of the Medicare Prescription Drug, Improvement, and 
                Modernization Act of 2003 (Public Law 108-173; 117 
                Stat. 2213)--
                            (i) by moving such subparagraph 2 ems to 
                        the left; and
                            (ii) by striking the period at the end and 
                        inserting a semicolon;
                    (C) in the subparagraph (H) added by section 431(a) 
                of such Act (117 Stat. 2287)--
                            (i) by redesignating such subparagraph as 
                        subparagraph (I);
                            (ii) by moving such subparagraph 2 ems to 
                        the left; and
                            (iii) by striking the period at the end and 
                        inserting ``; and''; and
                    (D) by adding at the end the following new 
                subparagraph:
            ``(J) any nonmonetary remuneration (in the form of health 
        information technology, as defined in section 1128A(i)(8), or 
        related installation, maintenance, support or training 
        services) made to a person by a specified entity (as defined in 
        subsection (g)) if--
                    ``(i) the provision of such remuneration is without 
                an agreement between the parties or legal condition 
                that--
                            ``(I) limits or restricts the use of the 
                        health information technology to services 
                        provided by the physician to individuals 
                        receiving services at the specified entity;
                            ``(II) limits or restricts the use of the 
                        health information technology in conjunction 
                        with other health information technology; or
                            ``(III) conditions the provision of such 
                        remuneration on the referral of patients or 
                        business to the specified entity;
                    ``(ii) such remuneration is arranged for in a 
                written agreement that is signed by the parties 
                involved (or their representatives) and that specifies 
                the remuneration solicited or received (or offered or 
                paid) and states that the provision of such 
                remuneration is made for the primary purpose of better 
                coordination of care or improvement of health quality, 
                efficiency, or research; and
                    ``(iii) the specified entity providing the 
                remuneration (or a representative of such entity) has 
                not taken any action to disable any basic feature of 
                any hardware or software component of such remuneration 
                that would permit interoperability.''; and
            (2) by adding at the end the following new subsection:
    ``(g) Specified Entity Defined.--For purposes of subsection 
(b)(3)(J), the term `specified entity' means an entity that is a 
hospital, group practice, prescription drug plan sponsor, a Medicare 
Advantage organization, or any other such entity specified by the 
Secretary, considering the goals and objectives of this section, as 
well as the goals to better coordinate the delivery of health care and 
to promote the adoption and use of health information technology.''.
    (c) Effective Date and Effect on State Laws.--
            (1) Effective date.--The amendments made by subsections (a) 
        and (b) shall take effect on the date that is 120 days after 
        the date of the enactment of this Act.
            (2) Preemption of state laws.--No State (as defined in 
        section 1101(a) of the Social Security Act (42 U.S.C. 1301(a)) 
        for purposes of title XI of such Act) shall have in effect a 
        State law that imposes a criminal or civil penalty for a 
        transaction described in section 1128A(b)(4) or section 
        1128B(b)(3)(J) of such Act, as added by subsections (a)(1) and 
        (b), respectively, if the conditions described in the 
        respective provision, with respect to such transaction, are 
        met.
    (d) Study and Report To Assess Effect of Safe Harbors on Health 
System.--
            (1) In general.--The Secretary of Health and Human Services 
        shall conduct a study to determine the impact of each of the 
        safe harbors described in paragraph (3). In particular, the 
        study shall examine the following:
                    (A) The effectiveness of each safe harbor in 
                increasing the adoption of health information 
                technology.
                    (B) The types of health information technology 
                provided under each safe harbor.
                    (C) The extent to which the financial or other 
                business relationships between providers under each 
                safe harbor have changed as a result of the safe harbor 
                in a way that adversely affects or benefits the health 
                care system or choices available to consumers.
                    (D) The impact of the adoption of health 
                information technology on health care quality, cost, 
                and access under each safe harbor.
            (2) Report.--Not later than 3 years after the effective 
        date described in subsection (c)(1), the Secretary of Health 
        and Human Services shall submit to Congress a report on the 
        study under paragraph (1).
            (3) Safe harbors described.--For purposes of paragraphs (1) 
        and (2), the safe harbors described in this paragraph are--
                    (A) the safe harbor under section 1128A(b)(4) of 
                such Act (42 U.S.C. 1320a-7a(b)(4)), as added by 
                subsection (a)(1); and
                    (B) the safe harbor under section 1128B(b)(3)(J) of 
                such Act (42 U.S.C. 1320a-7b(b)(3)(J)), as added by 
                subsection (b).

SEC. 232. EXCEPTION TO LIMITATION ON CERTAIN PHYSICIAN REFERRALS (UNDER 
              STARK) FOR PROVISION OF HEALTH INFORMATION TECHNOLOGY AND 
              TRAINING SERVICES TO HEALTH CARE PROFESSIONALS.

    (a) In General.--Section 1877(b) of the Social Security Act (42 
U.S.C. 1395nn(b)) is amended by adding at the end the following new 
paragraph:
            ``(6) Information technology and training services.--
                    ``(A) In general.--Any nonmonetary remuneration (in 
                the form of health information technology or related 
                installation, maintenance, support or training 
                services) made by a specified entity to a physician 
                if--
                            ``(i) the provision of such remuneration is 
                        without an agreement between the parties or 
                        legal condition that--
                                    ``(I) limits or restricts the use 
                                of the health information technology to 
                                services provided by the physician to 
                                individuals receiving services at the 
                                specified entity;
                                    ``(II) limits or restricts the use 
                                of the health information technology in 
                                conjunction with other health 
                                information technology; or
                                    ``(III) conditions the provision of 
                                such remuneration on the referral of 
                                patients or business to the specified 
                                entity;
                            ``(ii) such remuneration is arranged for in 
                        a written agreement that is signed by the 
                        parties involved (or their representatives) and 
                        that specifies the remuneration made and states 
                        that the provision of such remuneration is made 
                        for the primary purpose of better coordination 
                        of care or improvement of health quality, 
                        efficiency, or research; and
                            ``(iii) the specified entity (or a 
                        representative of such entity) has not taken 
                        any action to disable any basic feature of any 
                        hardware or software component of such 
                        remuneration that would permit 
                        interoperability.
                    ``(B) Health information technology defined.--For 
                purposes of this paragraph, the term `health 
                information technology' means hardware, software, 
                license, right, intellectual property, equipment, or 
                other information technology (including new versions, 
                upgrades, and connectivity) designed or provided 
                primarily for the electronic creation, maintenance, or 
                exchange of health information to better coordinate 
                care or improve health care quality, efficiency, or 
                research.
                    ``(C) Specified entity defined.--For purposes of 
                this paragraph, the term `specified entity' means an 
                entity that is a hospital, group practice, prescription 
                drug plan sponsor, a Medicare Advantage organization, 
                or any other such entity specified by the Secretary, 
                considering the goals and objectives of this section, 
                as well as the goals to better coordinate the delivery 
                of health care and to promote the adoption and use of 
                health information technology.''.
    (b) Effective Date; Effect on State Laws.--
            (1) Effective date.--The amendment made by subsection (a) 
        shall take effect on the date that is 120 days after the date 
        of the enactment of this Act.
            (2) Preemption of state laws.--No State (as defined in 
        section 1101(a) of the Social Security Act (42 U.S.C. 1301(a)) 
        for purposes of title XI of such Act) shall have in effect a 
        State law that imposes a criminal or civil penalty for a 
        transaction described in section 1877(b)(6) of such Act, as 
        added by subsection (a), if the conditions described in such 
        section, with respect to such transaction, are met.
    (c) Study and Report To Assess Effect of Exception on Health 
System.--
            (1) In general.--The Secretary of Health and Human Services 
        shall conduct a study to determine the impact of the exception 
        under section 1877(b)(6) of such Act (42 U.S.C. 1395nn(b)(6)), 
        as added by subsection (a). In particular, the study shall 
        examine the following:
                    (A) The effectiveness of the exception in 
                increasing the adoption of health information 
                technology.
                    (B) The types of health information technology 
                provided under the exception.
                    (C) The extent to which the financial or other 
                business relationships between providers under the 
                exception have changed as a result of the exception in 
                a way that adversely affects or benefits the health 
                care system or choices available to consumers.
                    (D) The impact of the adoption of health 
                information technology on health care quality, cost, 
                and access under the exception.
            (2) Report.--Not later than 3 years after the effective 
        date described in subsection (b)(1), the Secretary of Health 
        and Human Services shall submit to Congress a report on the 
        study under paragraph (1).

SEC. 233. RULES OF CONSTRUCTION REGARDING USE OF CONSORTIA.

    (a) Application to Safe Harbor From Criminal Penalties.--Section 
1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is 
amended by adding after and below subparagraph (J), as added by section 
231(b)(1), the following: ``For purposes of subparagraph (J), nothing 
in such subparagraph shall be construed as preventing a specified 
entity, consistent with the specific requirements of such subparagraph, 
from forming a consortium composed of health care providers, payers, 
employers, and other interested entities to collectively purchase and 
donate health information technology, or from offering health care 
providers a choice of health information technology products in order 
to take into account the varying needs of such providers receiving such 
products.''.
    (b) Application to Stark Exception.--Paragraph (6) of section 
1877(b) of the Social Security Act (42 U.S.C. 1395nn(b)), as added by 
section 232(a), is amended by adding at the end the following new 
subparagraph:
                    ``(D) Rule of construction.--For purposes of 
                subparagraph (A), nothing in such subparagraph shall be 
                construed as preventing a specified entity, consistent 
                with the specific requirements of such subparagraph, 
                from--
                            ``(i) forming a consortium composed of 
                        health care providers, payers, employers, and 
                        other interested entities to collectively 
                        purchase and donate health information 
                        technology; or
                            ``(ii) offering health care providers a 
                        choice of health information technology 
                        products in order to take into account the 
                        varying needs of such providers receiving such 
                        products.''.

         TITLE III--IMPROVING THE HEALTH OF THE AMERICAN PEOPLE

  Subtitle A--Modernizing Disease Prevention and Public Health Systems

SEC. 301. NATIONAL PREVENTION, HEALTH PROMOTION AND PUBLIC HEALTH 
              COUNCIL.

    (a) Establishment.--The President shall establish a council to be 
known as the ``National Prevention, Health Promotion and Public Health 
Council'' (referred to in this section as the ``Council'').
    (b) Chairperson.--The President shall appoint an individual to 
serve as the chairperson of the Council.
    (c) Composition.--The Council shall be composed of--
            (1) the Secretary of Health and Human Services;
            (2) the Secretary of Agriculture;
            (3) the Secretary of Education;
            (4) the Chairman of the Federal Trade Commission;
            (5) the Chairman of the Federal Communications Commission;
            (6) the Secretary of Transportation;
            (7) the Secretary of Defense;
            (8) the Secretary of Veterans Affairs;
            (9) the Secretary of the Interior;
            (10) the Secretary of Labor;
            (11) the Secretary of Homeland Security;
            (12) the Secretary of Housing and Urban Development;
            (13) the Director of the United States Patent and Trademark 
        Office;
            (14) the Administrator of the Environmental Protection 
        Agency;
            (15) the Director of the Domestic Policy Council;
            (16) the Director of the Office of Personnel Management;
            (17) the Director of the Office of National Drug Control 
        Policy;
            (18) the Chairman of the Corporation for National and 
        Community Service; and
            (19) the head of any other Federal agency that the 
        chairperson determines is appropriate.
    (d) Purposes and Duties.--The Council shall--
            (1) provide coordination and leadership at the Federal 
        level, and among all Federal departments and agencies, with 
        respect to prevention, wellness and health promotion practices, 
        the public health system, and integrative health care in the 
        United States;
            (2) after obtaining input from relevant stakeholders, 
        develop a national prevention, health promotion, public health, 
        and integrative health care strategy that incorporates the most 
        effective and achievable means of improving the health status 
        of Americans and reducing the incidence of preventable illness 
        and disability in the United States;
            (3) provide recommendations to the President and Congress 
        concerning the most pressing health issues confronting the 
        United States and changes in Federal policy to achieve national 
        wellness, health promotion, and public health goals, including 
        the reduction of tobacco use, sedentary behavior, and poor 
        nutrition;
            (4) consider and propose evidence-based models, policies, 
        and innovative approaches for the promotion of transformative 
        models of prevention, integrative health, and public health on 
        individual and community levels across the United States;
            (5) establish processes for continual public input, 
        including input from State, regional, and local leadership 
        communities and other relevant stakeholders, including Indian 
        tribes and tribal organizations;
            (6) submit the reports required under subsection (g); and
            (7) carry out other activities determined appropriate by 
        the President.
    (e) Meetings.--The Council shall meet at the call of the 
Chairperson.
    (f) National Prevention and Health Promotion Strategy.--Not later 
than 1 year after the date of enactment of this Act, the Chairperson, 
in consultation with the Council, shall develop and make public a 
national prevention, health promotion and public health strategy, and 
shall review and revise such strategy periodically. Such strategy 
shall--
            (1) set specific goals and objectives for improving the 
        health of the United States through federally-supported 
        prevention, health promotion, and public health programs, 
        consistent with ongoing goal setting efforts conducted by 
        specific agencies;
            (2) establish specific and measurable actions and timelines 
        to carry out the strategy, and determine accountability for 
        meeting those timelines, within and across Federal departments 
        and agencies; and
            (3) make recommendations to improve Federal efforts 
        relating to prevention, health promotion, public health, and 
        integrative health care practices to ensure Federal efforts are 
        consistent with available standards and evidence.
    (g) Report.--Not later than July 1, 2010, and annually thereafter 
through January 1, 2015, the Council shall submit to the President and 
the relevant committees of Congress, a report that--
            (1) describes the activities and efforts on prevention, 
        health promotion, and public health and activities to develop a 
        national strategy conducted by the Council during the period 
        for which the report is prepared;
            (2) describes the national progress in meeting specific 
        prevention, health promotion, and public health goals defined 
        in the strategy and further describes corrective actions 
        recommended by the Council and taken by relevant agencies and 
        organizations to meet these goals;
            (3) contains a list of national priorities on health 
        promotion and disease prevention to address lifestyle behavior 
        modification (smoking cessation, proper nutrition, and 
        appropriate exercise) and the prevention measures for the 5 
        leading disease killers in the United States;
            (4) contains specific science-based initiatives to achieve 
        the measurable goals of Healthy People 2010 regarding 
        nutrition, exercise, and smoking cessation, and targeting the 5 
        leading disease killers in the United States;
            (5) contains specific plans for consolidating Federal 
        health programs and Centers that exist to promote healthy 
        behavior and reduce disease risk (including eliminating 
        programs and offices determined to be ineffective in meeting 
        the priority goals of Healthy People 2010);
            (6) contains specific plans to ensure that all Federal 
        health care programs are fully coordinated with science-based 
        prevention recommendations by the Director of the Centers for 
        Disease Control and Prevention;
            (7) contains specific plans to ensure that all non-
        Department of Health and Human Services prevention programs are 
        based on the science-based guidelines developed by the Centers 
        for Disease Control and Prevention under paragraph (4); and
            (8) contains a list of new non-Federal and non-government 
        partners identified by the council to build Federal capacity in 
        health promotion and disease prevention efforts.
    (h) Periodic Reviews.--The Secretary and the Comptroller General of 
the United States shall jointly conduct periodic reviews, not less than 
every 5 years, and evaluations of every Federal disease prevention and 
health promotion initiative, program, and agency. Such reviews shall be 
evaluated based on effectiveness in meeting metrics-based goals with an 
analysis posted on such agencies' public Internet websites.
    (i) Annual Request to Give Testimony.--The Chairperson shall 
annually request an opportunity to testify before Congress concerning--
            (1) the progress made by the United States in meeting the 
        prevention, health promotion, and public health goals defined 
        in the strategy and the effectiveness of Federal programs 
        related to these goals; and
            (2) the amount and sources of Federal funds that are 
        targeted to prevention, health promotion, and public health 
        initiatives and results of program evaluations.

SEC. 302. PREVENTION AND PUBLIC HEALTH FUND.

    (a) Purpose.--It is the purpose of this section to establish a 
Prevention and Public Health Fund (referred to in this section as the 
``Fund''), to be administered through the Department of Health and 
Human Services, Office of the Secretary, to provide for expanded and 
sustained national investment in prevention and public health programs 
to improve health and help restrain the rate of growth in private and 
public sector health care costs.
    (b) Funding.--There are hereby authorized to be appropriated, and 
appropriated, to the Fund, out of any monies in the Treasury not 
otherwise appropriated--
            (1) for fiscal year 2010, $2,000,000,000;
            (2) for fiscal year 2011, $4,000,000,000;
            (3) for fiscal year 2012, $6,000,000,000;
            (4) for fiscal year 2013, $8,000,000,000;
            (5) for fiscal year 2014, $10,000,000,000;
            (6) for fiscal year 2015, $ 10,000,000,000;
            (7) for fiscal year 2016, $10,000,000,000;
            (8) for fiscal year 2017, $10,000,000,000;
            (9) for fiscal year 2018, $10,000,000,000; and
            (10) for fiscal year 2019, and each fiscal year thereafter, 
        $10,000,000,000.
    (c) Use of Fund.--The Secretary shall transfer amounts in the Fund 
to accounts within the Department of Health and Human Services to 
increase funding, over the fiscal year 2008 level, for programs 
authorized by the Public Health Service Act, for prevention, wellness 
and public health activities including prevention research and health 
screenings. Such transfers shall be subject to the transfer authority 
provided for in the annual appropriations Act for the fiscal year in 
which the funds become available.
    (d) Transfer Authority .--The Committee on Appropriations of the 
Senate and the Committee on Appropriations of the House of 
Representatives may provide for the transfer of funds in the Fund to 
eligible activities under this section, subject to subsection (c).

SEC. 303. CLINICAL AND COMMUNITY PREVENTIVE SERVICES.

    (a) Preventive Services Task Force.--Section 915 of the Public 
Health Service Act (42 U.S.C. 299b-4) is amended by striking subsection 
(a) and inserting the following:
    ``(a) Preventive Services Task Force.--
            ``(1) Establishment and purpose.--The Director shall 
        convene an independent Preventive Services Task Force (referred 
        to in this subsection as the `Task Force') to be composed of 
        individuals with appropriate expertise. Such Task Force shall 
        review the scientific evidence related to the effectiveness, 
        appropriateness, and cost-effectiveness of clinical preventive 
        services for the purpose of developing recommendations for the 
        health care community, and updating previous clinical 
        preventive recommendations, to be published in the Guide to 
        Clinical Preventive Services (referred to in this section as 
        the `Guide'), for individuals and organizations delivering 
        clinical services, including primary care professionals, health 
        care systems, professional societies, employers, community 
        organizations, non-profit organizations, Congress and other 
        policy-makers, governmental public health agencies, health care 
        quality organizations, and organizations developing national 
        health objectives. Such recommendations shall consider clinical 
        preventive best practice recommendations from the Agency for 
        Healthcare Research and Quality, the National Institutes of 
        Health, the Centers for Disease Control and Prevention, the 
        Institute of Medicine, specialty medical associations, patient 
        groups, and scientific societies.
            ``(2) Duties.--The duties of the Task Force shall include--
                    ``(A) the development of additional topic areas for 
                new recommendations and interventions related to those 
                topic areas, including those related to specific sub-
                populations and age groups;
                    ``(B) at least once during every 5-year period, 
                review interventions and update recommendations related 
                to existing topic areas, including new or improved 
                techniques to assess the health effects of 
                interventions;
                    ``(C) improved integration with Federal Government 
                health objectives and related target setting for health 
                improvement;
                    ``(D) the enhanced dissemination of 
                recommendations;
                    ``(E) the provision of technical assistance to 
                those health care professionals, agencies and 
                organizations that request help in implementing the 
                Guide recommendations; and
                    ``(F) the submission of yearly reports to Congress 
                and related agencies identifying gaps in research, such 
                as preventive services that receive an insufficient 
                evidence statement, and recommending priority areas 
                that deserve further examination, including areas 
                related to populations and age groups not adequately 
                addressed by current recommendations.
            ``(3) Role of agency.--The Agency shall provide ongoing 
        administrative, research, and technical support for the 
        operations of the Task Force, including coordinating and 
        supporting the dissemination of the recommendations of the Task 
        Force, ensuring adequate staff resources, and assistance to 
        those organizations requesting it for implementation of the 
        Guide's recommendations.
            ``(4) Coordination with community preventive services task 
        force.--The Task Force shall take appropriate steps to 
        coordinate its work with the Community Preventive Services Task 
        Force and the Advisory Committee on Immunization Practices, 
        including the examination of how each task force's 
        recommendations interact at the nexus of clinic and community.
            ``(5) Operation.--Operation. In carrying out the duties 
        under paragraph (2), the Task Force is not subject to the 
        provisions of Appendix 2 of title 5, United States Code.
            ``(6) Independence.--All members of the Task Force convened 
        under this subsection, and any recommendations made by such 
        members, shall be independent and, to the extent practicable, 
        not subject to political pressure.
            ``(7) Authorization of appropriations.--There are 
        authorized to be appropriated such sums as may be necessary for 
        each fiscal year to carry out the activities of the Task 
        Force.''.
    (b) Community Preventive Services Task Force.--Part P of title III 
of the Public Health Service Act is amended by adding at the end the 
following:

``SEC. 399S. COMMUNITY PREVENTIVE SERVICES TASK FORCE.

    ``(a) Establishment and Purpose.--The Director of the Centers for 
Disease Control and Prevention shall convene an independent Community 
Preventive Services Task Force (referred to in this subsection as the 
`Task Force') to be composed of individuals with appropriate expertise. 
Such Task Force shall review the scientific evidence related to the 
effectiveness, appropriateness, and cost-effectiveness of community 
preventive interventions for the purpose of developing recommendations, 
to be published in the Guide to Community Preventive Services (referred 
to in this section as the `Guide'), for individuals and organizations 
delivering population-based services, including primary care 
professionals, health care systems, professional societies, employers, 
community organizations, non-profit organizations, schools, 
governmental public health agencies, Indian tribes, tribal 
organizations and urban Indian organizations, medical groups, Congress 
and other policy-makers. Community preventive services include any 
policies, programs, processes or activities designed to affect or 
otherwise affecting health at the population level.
    ``(b) Duties.--The duties of the Task Force shall include--
            ``(1) the development of additional topic areas for new 
        recommendations and interventions related to those topic areas, 
        including those related to specific populations and age groups, 
        as well as the social, economic and physical environments that 
        can have broad effects on the health and disease of populations 
        and health disparities among sub-populations and age groups;
            ``(2) at least once during every 5-year period, review 
        interventions and update recommendations related to existing 
        topic areas, including new or improved techniques to assess the 
        health effects of interventions, including health impact 
        assessment and population health modeling;
            ``(3) improved integration with Federal Government health 
        objectives and related target setting for health improvement;
            ``(4) the enhanced dissemination of recommendations;
            ``(5) the provision of technical assistance to those health 
        care professionals, agencies, and organizations that request 
        help in implementing the Guide recommendations; and
            ``(6) providing yearly reports to Congress and related 
        agencies identifying gaps in research and recommending priority 
        areas that deserve further examination, including areas related 
        to populations and age groups not adequately addressed by 
        current recommendations.
    ``(c) Role of Agency.--The Director shall provide ongoing 
administrative, research, and technical support for the operations of 
the Task Force, including coordinating and supporting the dissemination 
of the recommendations of the Task Force, ensuring adequate staff 
resources, and assistance to those organizations requesting it for 
implementation of Guide recommendations.
    ``(d) Coordination With Preventive Services Task Force.--The Task 
Force shall take appropriate steps to coordinate its work with the U.S. 
Preventive Services Task Force and the Advisory Committee on 
Immunization Practices, including the examination of how each task 
force's recommendations interact at the nexus of clinic and community.
    ``(e) Operation.--In carrying out the duties under subsection (b), 
the Task Force shall not be subject to the provisions of Appendix 2 of 
title 5, United States Code.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for each fiscal year to 
carry out the activities of the Task Force.''.

SEC. 304. EDUCATION AND OUTREACH CAMPAIGN REGARDING PREVENTIVE 
              BENEFITS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall provide for 
the planning and implementation of a national public-private 
partnership for a prevention and health promotion outreach and 
education campaign to raise public awareness of health improvement 
across the life span. Such campaign shall include the dissemination of 
information that--
            (1) describes the importance of utilizing preventive 
        services to promote wellness, reduce health disparities, and 
        mitigate chronic disease;
            (2) promotes the use of preventive services recommended by 
        the United States Preventive Services Task Force and the 
        Community Preventive Services Task Force;
            (3) encourages healthy behaviors linked to the prevention 
        of chronic diseases;
            (4) explains the preventive services covered under health 
        plans offered through a Gateway;
            (5) describes additional preventive care supported by the 
        Centers for Disease Control and Prevention, the Health 
        Resources and Services Administration, the Substance Abuse and 
        Mental Health Services Administration, the Advisory Committee 
        on Immunization Practices, and other appropriate agencies; and
            (6) includes general health promotion information.
    (b) Consultation.--In coordinating the campaign under subsection 
(a), the Secretary shall consult with the Institute of Medicine to 
provide ongoing advice on evidence-based scientific information for 
policy, program development, and evaluation.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.

     Subtitle B--Increasing Access to Clinical Preventive Services

SEC. 311. RIGHT CHOICES PROGRAM.

    (a) In General.--Beginning on the date of enactment of this Act, 
the Secretary shall award an annual grant to each State for the 
establishment of ``Right Choices Programs''.
    (b) Administration.--A State shall use amounts received under a 
grant under subsection (a) to establish and implement a Right Choices 
Program. A State may administer the program through the State Medicaid 
program or through a comparable program. Under such program the State 
shall--
            (1) conduct outreach activities through State health and 
        human services programs, through safety net facilities, or 
        through other mechanisms determined appropriate by the State 
        and the Secretary, to identify uninsured individuals; and
            (2) provide individuals identified under paragraph (1), who 
        are eligible individuals, with a Right Choices Card to be used 
        to access the services described in subsection (d).
    (c) Eligible Individuals.--To be eligible to participate in a Right 
Choices program under this section, an individual shall--
            (1) be a citizen or national of the United States or an 
        alien lawfully admitted to the United States for permanent 
        residence or otherwise residing in the United States under 
        color of law;
            (2) not be covered under any health insurance coverage 
        during the 6-month period immediately preceding the date of the 
        determination of eligibility;
            (3) have a family income that does not exceed 350 percent 
        of the Federal poverty level for a family of the size involved; 
        and
            (4) not be eligible for health care benefits provided 
        through Medicare, Medicaid, the State Children's Health 
        Insurance Program, the armed services, or the Department of 
        Veterans Affairs.
    (d) Services.--Services described in this subsection include the 
following:
            (1) Risk-stratified care plan.--
                    (A) In general.--An eligible individual 
                participating in the Right Choices Program shall 
                receive--
                            (i) a one-time health risk appraisal; and
                            (ii) a risk-stratified care plan provided 
                        by a primary care professional who may be 
                        affiliated with the Medicare or Medicaid 
                        programs under title XVIII or XIX of the Social 
                        Security Act, or with a Federal or State safety 
                        net provider (such as a community care team, 
                        community health center, or rural health 
                        clinic, as identified by the State).
                    (B) Referrals.--A care plan under subparagraph 
                (A)--
                            (i) shall include recommendations for 
                        behavioral changes, referrals to community-
                        based resources, and referrals for age and 
                        gender appropriate immunizations and screenings 
                        to prevent chronic diseases (as identified by 
                        the Secretary, in consultation with the 
                        Director of the Centers for Disease Control and 
                        Prevention, the Administrator of the Agency for 
                        Healthcare Research and Quality, the 
                        Administrator of the Health Resources and 
                        Services Administration, the Administrator of 
                        the Substance Abuse and Mental Health Services 
                        Administration, and other appropriate sources); 
                        and
                            (ii) to the extent feasible, shall include 
                        referrals by the State of individuals to State 
                        and Federal programs for which they may be 
                        eligible.
            (2) Treatment.--An eligible individual participating in the 
        Right Choices Program who has been diagnosed with an illnesses 
        shall be referred for treatment to existing Federal or State 
        safety net providers or facilities, as appropriate (such as 
        public hospitals, community health centers, and rural health 
        clinics).
    (e) Payment of Providers.--
            (1) In general.--The State shall be required to reimburse 
        health care providers that provide services to individuals 
        under the Right Choices Program. Such reimbursement shall be 
        approved by the Secretary and determined based on the amount 
        paid by the State for similar services under the Medicaid 
        program in the State. Such reimbursement shall not exceed the 
        reimbursement provided for similar services under the Medicare 
        program.
            (2) Cost sharing.--A State shall require that an eligible 
        individual with a family income that exceeds 200 percent of the 
        Federal poverty level for a family of the size involved that is 
        participating in the State's Right Choices Program, contribute 
        a portion of the cost of care under such Program on a sliding 
        scale as determined by the Secretary.
    (f) Amount of Grant.--The amount of a grant to a State under this 
section for a year shall be determined by the Secretary based on the 
rates of uninsured per capita of adults and children in the State (as 
compared to all States) and the prevalence of the most common costly 
chronic diseases in the State (as compared to all States). The 
Secretary shall determine what amount of the grant can be used for 
State administration of the program. The Secretary may also set aside 
not more than 20 percent of the funds appropriated to carry out this 
section to allocate to programs that fund the treatment of individuals 
participating in a Right Choices Program.
    (g) Payments.--The Secretary shall determine the manner in which 
payments shall be made to States under this section on a prospective 
basis to enable the State to provide individuals with access to items 
and services until the Federal or State Gateways are available.
    (h) Limitation on Funds.--The Secretary shall not obligate in 
excess of $5,000,000,000 for any fiscal year under this section.
    (i) Definition.--In this section, the term ``State'' means each of 
the several States, the District of Columbia, and each of the 
territories of the United States, and shall include Indian tribes and 
tribal organizations (as such terms are defined in section 4(b) and 
section 4(c) of the Indian Self-Determination and Education Assistance 
Act).
    (j) Evaluation.--The Secretary shall conduct an annual evaluation 
of the effectiveness of the pilot program under this section.
    (k) Limitation.--Nothing in this title (or an amendment made by 
this title) shall require that a State use State revenue to fund 
programs under this section.
    (l) Sunset.--The program under this section shall terminate with 
respect to a State, on the date on which the Federal or State Gateways 
are available.

SEC. 312. SCHOOL-BASED HEALTH CLINICS.

    Part Q of title III of the Public Health Service Act (42 U.S.C. 
280h et seq.) is amended by adding at the end the following:

``SEC. 399Z-1. SCHOOL-BASED HEALTH CLINICS.

    ``(a) Definitions; Establishment of Criteria.--In this section:
            ``(1) Comprehensive primary health services.--The term 
        `comprehensive primary health services' means the core services 
        offered by school-based health clinics, which shall include the 
        following:
                    ``(A) Physical.--Comprehensive health assessments, 
                diagnosis, and treatment of minor, acute, and chronic 
                medical conditions, and referrals to, and follow-up 
                for, specialty care and oral health services.
                    ``(B) Mental health.--Mental health and substance 
                use disorder assessments, crisis intervention, 
                counseling, treatment, and referral to a continuum of 
                services including emergency psychiatric care, 
                community support programs, inpatient care, and 
                outpatient programs.
            ``(2) Medically underserved children and adolescents.--
                    ``(A) In general.--The term `medically underserved 
                children and adolescents' means a population of 
                children and adolescents who are residents of an area 
                designated as a medically underserved area or a health 
                professional shortage area by the Secretary.
                    ``(B) Criteria.--The Secretary shall prescribe 
                criteria for determining the specific shortages of 
                personal health services for medically underserved 
                children and adolescents under subparagraph (A) that 
                shall--
                            ``(i) take into account any comments 
                        received by the Secretary from the chief 
                        executive officer of a State and local 
                        officials in a State; and
                            ``(ii) include factors indicative of the 
                        health status of such children and adolescents 
                        of an area, including the ability of the 
                        residents of such area to pay for health 
                        services, the accessibility of such services, 
                        the availability of health professionals to 
                        such children and adolescents, and other 
                        factors as determined appropriate by the 
                        Secretary.
            ``(3) School-based health clinic.--The term `school-based 
        health clinic' means a health clinic that--
                    ``(A) is located in or near a school facility of a 
                school district or board;
                    ``(B) is organized through school, community, and 
                health provider relationships;
                    ``(C) is administered by a sponsoring facility; and
                    ``(D) provides, at a minimum, comprehensive primary 
                health services during school hours to children and 
                adolescents by health professionals in accordance with 
                established standards, community practice, reporting 
                laws, and other State laws, including parental consent 
                and notification laws that are not inconsistent with 
                Federal law.
            ``(4) Sponsoring facility.--The term `sponsoring facility' 
        is a community-based organization, which may include--
                    ``(A) a hospital;
                    ``(B) a public health department;
                    ``(C) a community health center;
                    ``(D) a nonprofit health care agency;
                    ``(E) a local education agency;
                    ``(F) a faith-based organization; or
                    ``(G) any other entity determined appropriate by 
                the Secretary.
    ``(b) Authority to Award Grants.--The Secretary shall award grants 
for the costs of the operation of school-based health clinics (referred 
to in this section as `SBHCs') that meet the requirements of this 
section.
    ``(c) Applications.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be an SBHC (as defined in subsection (a)(4)); and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing--
                    ``(A) evidence that the applicant meets all 
                criteria necessary to be designated an SBHC;
                    ``(B) evidence of local need for the services to be 
                provided by the SBHC;
                    ``(C) an assurance that--
                            ``(i) SBHC services will be provided to 
                        those children and adolescents for whom 
                        parental or guardian consent has been obtained 
                        in cooperation with Federal, State, and local 
                        laws governing health care service provision to 
                        children and adolescents;
                            ``(ii) the SBHC has made and will continue 
                        to make every reasonable effort to establish 
                        and maintain collaborative relationships with 
                        other health care providers in the catchment 
                        area of the SBHC;
                            ``(iii) the SBHC will provide on-site 
                        access during the academic day when school is 
                        in session and 24-hour coverage through an on-
                        call system and through its backup health 
                        providers to ensure access to services on a 
                        year-round basis when the school or the SBHC is 
                        closed;
                            ``(iv) the SBHC will be integrated into the 
                        school environment and will coordinate health 
                        services with school personnel, such as 
                        administrators, teachers, nurses, counselors, 
                        and support personnel, as well as with other 
                        community providers co-located at the school;
                            ``(v) the SBHC sponsoring facility assumes 
                        all responsibility for the SBHC administration, 
                        operations, and oversight; and
                            ``(vi) the SBHC will comply with Federal, 
                        State, and local laws concerning patient 
                        privacy and student records, including 
                        regulations promulgated under the Health 
                        Insurance Portability and Accountability Act of 
                        1996 and section 444 of the General Education 
                        Provisions Act; and
                    ``(D) such other information as the Secretary may 
                require.
    ``(d) Preferences.--In reviewing applications, the Secretary may 
give preference to applicants who demonstrate an ability to serve the 
following:
            ``(1) Communities that have evidenced barriers to primary 
        health care and mental health and substance use disorder 
        prevention services for children and adolescents.
            ``(2) Communities with high per capita numbers of children 
        and adolescents who are uninsured, underinsured, or enrolled in 
        public health insurance programs.
            ``(3) Populations of children and adolescents that have 
        historically demonstrated difficulty in accessing health and 
        mental health and substance use disorder prevention services.
    ``(e) Waiver of Requirements.--The Secretary may--
            ``(1) under appropriate circumstances, waive the 
        application of all or part of the requirements of this 
        subsection with respect to an SBHC for not to exceed 2 years; 
        and
            ``(2) upon a showing of good cause, waive the requirement 
        that the SBHC provide all required comprehensive primary health 
        services for a designated period of time to be determined by 
        the Secretary.
    ``(f) Use of Funds.--
            ``(1) Funds.--Funds awarded under a grant under this 
        section may be used for
                    ``(A) acquiring and leasing equipment (including 
                the costs of amortizing the principle of, and paying 
                interest on, loans for such equipment);
                    ``(B) providing training related to the provision 
                of required comprehensive primary health services and 
                additional health services;
                    ``(C) the management and operation of health center 
                programs; and
                    ``(D) the payment of salaries for physicians, 
                nurses, and other personnel of the SBHC.
            ``(2) Construction.--The Secretary may award grants which 
        may be used to pay the costs associated with expanding and 
        modernizing existing buildings for use as an SBHC, including 
        the purchase of trailers or manufactured buildings to install 
        on the school property.
            ``(3) Amount.--The amount of any grant made in any fiscal 
        year to an SBHC shall be determined by the Secretary, taking 
        into account--
                    ``(A) the financial need of the SBHC;
                    ``(B) State, local, or other operation funding 
                provided to the SBHC; and
                    ``(C) other factors as determined appropriate by 
                the Secretary.
            ``(4) Limitation.--Any provider of services that is 
        determined by a State to be in violation of a State law 
        described in subsection (a)(4)(D) with respect to activities 
        carried out at a SBHC shall not be eligible to receive 
        additional funding under this section.
    ``(g) Matching Requirement.--
            ``(1) In general.--Each eligible entity that receives a 
        grant under this section shall provide, from non-Federal 
        sources, an amount equal to 20 percent of the amount of the 
        grant (which may be provided in cash or in-kind) to carry out 
        the activities supported by the grant.
            ``(2) Waiver.--The Secretary may waive all or part of the 
        matching requirement described in paragraph (1) for any fiscal 
        year for the SBHC if the Secretary determines that applying the 
        matching requirement to the SBHC would result in serious 
        hardship or an inability to carry out the purposes of this 
        section.
    ``(h) Supplement, Not Supplant.--Grant funds provided under this 
section shall be used to supplement, not supplant, other Federal or 
State funds.
    ``(i) Technical Assistance.--The Secretary shall establish a 
program through which the Secretary shall provide (either through the 
Department of Health and Human Services or by grant or contract) 
technical and other assistance to SBHCs to assist such SBHCs to meet 
the requirements of subsection (c)(2)(C). Services provided through the 
program may include necessary technical and nonfinancial assistance, 
including fiscal and program management assistance, training in fiscal 
and program management, operational and administrative support, and the 
provision of information to the entities of the variety of resources 
available under this title and how those resources can be best used to 
meet the health needs of the communities served by the entities.
    ``(j) Evaluation.--The Secretary shall develop and implement a plan 
for evaluating SBHCs and monitoring quality performance under the 
awards made under this section.
    ``(k) Age Appropriate Services.--An eligible entity receiving funds 
under this section shall only provide age appropriate services through 
a SBHC funded under this section to an individual.
    ``(l) Authorization of Appropriations.--For purposes of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2010 through 2014.''.

SEC. 313. ORAL HEALTHCARE PREVENTION ACTIVITIES.

    (a) In General.--Title III of the Public Health Service Act (42 
U.S.C. 241 et seq.) is amended by adding at the end the following:

            ``PART S--ORAL HEALTHCARE PREVENTION ACTIVITIES

``SEC. 399GG. ORAL HEALTHCARE PREVENTION EDUCATION CAMPAIGN.

    ``(a) Establishment.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention and in consultation with 
professional oral health organizations, shall, subject to the 
availability of appropriations, establish a 5-year national, public 
education campaign (referred to in this section as the `campaign') that 
is focused on oral healthcare prevention and education, including 
prevention of oral disease such as early childhood and other caries, 
periodontal disease, and oral cancer.
    ``(b) Requirements.--In establishing the campaign, the Secretary 
shall--
            ``(1) ensure that activities are targeted towards specific 
        populations such as children, pregnant women, parents, the 
        elderly, individuals with disabilities, and ethnic and racial 
        minority populations, including Indians, Alaska Natives and 
        Native Hawaiians (as defined in section 4(c) of the Indian 
        Health Care Improvement Act) in a culturally and linguistically 
        appropriate manner; and
            ``(2) utilize science-based strategies to convey oral 
        health prevention messages that include, but are not limited 
        to, community water fluoridation and dental sealants.
    ``(c) Planning and Implementation.--Not later than 2 years after 
the date of enactment of this section, the Secretary shall begin 
implementing the 5-year campaign. During the 2-year period referred to 
in the previous sentence, the Secretary shall conduct planning 
activities with respect to the campaign.

``SEC. 399GG-1. RESEARCH-BASED DENTAL CARIES DISEASE MANAGEMENT.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall award 
demonstration grants to eligible entities to demonstrate the 
effectiveness of research-based dental caries disease management 
activities.
    ``(b) Eligibility.--To be eligible for a grant under this section, 
an entity shall--
            ``(1) be a community-based provider of dental services (as 
        defined by the Secretary), including a Federally-qualified 
        health center, a clinic of a hospital owned or operated by a 
        State (or by an instrumentality or a unit of government within 
        a State), a State or local department of health, a dental 
        program of the Indian Health Service, an Indian tribe or tribal 
        organization, or an urban Indian organization (as such terms 
        are defined in section 4 of the Indian Health Care Improvement 
        Act), a health system provider, a private provider of dental 
        services, medical, dental, public health, nursing, nutrition 
        educational institutions, or national organizations involved in 
        improving children's oral health; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--A grantee shall use amounts received under a 
grant under this section to demonstrate the effectiveness of research-
based dental caries disease management activities.
    ``(d) Use of Information.--The Secretary shall utilize information 
generated from grantees under this section in planning and implementing 
the public education campaign under section 399GG.

``SEC. 399GG-2. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this part, 
such sums as may be necessary.''.

SEC. 314. ORAL HEALTH IMPROVEMENT.

    (a) School-based Sealant Programs.--Section 317M(c)(1) of the 
Public Health Service Act (42 U.S.C. 247b-14(c)(1)) is amended by 
striking ``may award grants to States and Indian tribes'' and inserting 
``shall award a grant to each of the 50 States and territories and to 
Indians, Indian tribes, tribal organizations and urban Indian 
organizations (as such terms are defined in section 4 of the Indian 
Health Care Improvement Act)''.
    (b) Oral Health Infrastructure.--Section 317M of the Public Health 
Service Act (42 U.S.C. 247b-14) is amended--
            (1) by redesignating subsections (d) and (e) as subsections 
        (e) and (f), respectively; and
            (2) by inserting after subsection (c), the following:
    ``(d) Oral Health Infrastructure.--
            ``(1) Cooperative agreements.--The Secretary, acting 
        through the Director of the Centers for Disease Control and 
        Prevention, shall enter into cooperative agreements with State, 
        territorial, and Indian tribes or tribal organizations (as 
        those terms are defined in section 4 of the Indian Health Care 
        Improvement Act) to establish oral health leadership and 
        program guidance, oral health data collection and 
        interpretation, (including determinants of poor oral health 
        among vulnerable populations), a multi-dimensional delivery 
        system for oral health, and to implement science-based programs 
        (including dental sealants and community water fluoridation) to 
        improve oral health.
            ``(2) Authorization of appropriations.--There is authorized 
        to be appropriated such sums as necessary to carry out this 
        subsection for fiscal years 2010 through 2014.''.
    (c) Updating National Oral Healthcare Surveillance Activities.--
            (1) PRAMS.--
                    (A) In general.--The Secretary of Health and Human 
                Services (referred to in this subsection as the 
                ``Secretary'') shall carry out activities to update and 
                improve the Pregnancy Risk Assessment Monitoring System 
                (referred to in this section as ``PRAMS'') as it 
                relates to oral healthcare.
                    (B) State reports and mandatory measurements.--
                            (i) In general.--Not later than 5 years 
                        after the date of enactment of this Act, and 
                        every 5 years thereafter, a State shall submit 
                        to the Secretary a report concerning activities 
                        conducted within the State under PRAMS.
                            (ii) Measurements.--The oral healthcare 
                        measurements developed by the Secretary for use 
                        under PRAMS shall be mandatory with respect to 
                        States for purposes of the State reports under 
                        clause (i).
                    (C) Funding.--There is authorized to be 
                appropriated to carry out this paragraph, such sums as 
                may be necessary.
            (2) National health and nutrition examination survey.--The 
        Secretary shall develop oral healthcare components that shall 
        include tooth-level surveillance for inclusion in the National 
        Health and Nutrition Examination Survey. Such components shall 
        be updated by the Secretary at least every 6 years. For 
        purposes of this paragraph, the term ``tooth-level 
        surveillance'' means a clinical examination where an examiner 
        looks at each dental surface, on each tooth in the mouth and as 
        expanded by the Division of Oral Health of the Centers for 
        Disease Control and Prevention.
            (3) Medical expenditures panel survey.--The Secretary shall 
        ensure that the Medical Expenditures Panel Survey by the Agency 
        for Healthcare Research and Quality includes the verification 
        of dental utilization, expenditure, and coverage findings 
        through conduct of a look-back analysis.
            (4) National oral health surveillance system.--
                    (A) Appropriations.--There is authorized to be 
                appropriated, such sums as may be necessary for each of 
                fiscal years 2010 through 2014 to increase the 
                participation of States in the National Oral Health 
                Surveillance System from 16 States to all 50 States, 
                territories, and District of Columbia.
                    (B) Requirements.--The Secretary shall ensure that 
                the National Oral Health Surveillance System include 
                the measurement of early childhood caries.

               Subtitle C--Creating Healthier Communities

SEC. 321. COMMUNITY TRANSFORMATION GRANTS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), acting through the 
Director of the Centers for Disease Control and Prevention (referred to 
in this section as the ``Director''), shall award competitive grants to 
State and local governmental agencies and community-based organizations 
for the implementation, evaluation, and dissemination of evidence-based 
community preventive health activities in order to reduce chronic 
disease rates, address health disparities, and develop a stronger 
evidence-base of effective prevention programming.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            (1) be a--
                    (A) State governmental agency;
                    (B) local governmental agency;
                    (C) national network of community-based 
                organizations; or
                    (D) Indian tribe; and
            (2) submit to the Director an application at such time, in 
        such a manner, and containing such information as the Director 
        may require, including a description of the program to be 
        carried out under the grant; and
            (3) demonstrate a history or capacity, if funded, to 
        develop relationships necessary to engage key stakeholders from 
        multiple sectors across a community, such as healthy futures 
        corps.
    (c) Use of Funds.--
            (1) In general.--An eligible entity shall use amounts 
        received under a grant under this section to carry out programs 
        described in this subsection.
            (2) Community transformation plan.--
                    (A) In general.--An eligible entity that receives a 
                grant under this section shall submit to the Director 
                (for approval) a detailed plan that includes the 
                policy, environmental, programmatic, and as appropriate 
                infrastructure changes needed to promote healthy living 
                and reduce disparities.
                    (B) Activities.--Activities within the plan may 
                focus on (but not be limited to)--
                            (i) creating healthier school environments, 
                        including increasing healthy food options, 
                        physical activity opportunities, promotion of 
                        healthy lifestyle and prevention curricula, and 
                        activities to prevent chronic diseases;
                            (ii) creating the infrastructure to support 
                        active living and access to nutritious foods in 
                        a safe environment;
                            (iii) developing and promoting programs 
                        targeting a variety of age levels to increase 
                        access to nutrition, physical activity and 
                        smoking cessation, enhance safety in a 
                        community, or address any other chronic disease 
                        priority area identified by the grantee;
                            (iv) assessing and implementing worksite 
                        wellness programming and incentives;
                            (v) working to highlight healthy options at 
                        restaurants and other food venues;
                            (vi) prioritizing strategies to reduce 
                        racial and ethnic disparities, including social 
                        determinants of health; and
                            (vii) addressing the needs of special 
                        populations, including all age groups and 
                        individuals with disabilities.
            (3) Community-based prevention health activities.--
                    (A) In general.--An eligible entity shall use 
                amounts received under a grant under this section to 
                implement a variety of programs, policies, and 
                infrastructure improvements to promote healthier 
                lifestyles.
                    (B) Activities.--An eligible entity shall implement 
                activities detailed in the community transformation 
                plan under paragraph (2).
                    (C) In-kind support.--An eligible entity shall 
                provide in-kind resources such as staff, equipment, or 
                office space in carrying out activities under this 
                section.
            (4) Evaluation.--
                    (A) In general.--An eligible entity shall use 
                amounts provided under a grant under this section to 
                conduct activities to measure changes in the prevalence 
                of chronic disease risk factors among community members 
                participating in preventive health activities
                    (B) Types of measures.--In carrying out 
                subparagraph (A), the eligible entity shall, with 
                respect to residents in the community, measure--
                            (i) changes in weight;
                            (ii) changes in proper nutrition;
                            (iii) changes in physical activity;
                            (iv) changes in tobacco use prevalence;
                            (v) other factors using community-specific 
                        data from the Behavioral Risk Factor 
                        Surveillance Survey; and
                            (vi) other factors as determined by the 
                        Secretary.
                    (C) Reporting.--An eligible entity shall annually 
                submit to the Director a report containing an 
                evaluation of activities carried out under the grant.
            (5) Dissemination.--A grantee under this section shall--
                    (A) meet at least annually in regional or national 
                meetings to discuss challenges, best practices, and 
                lessons learned with respect to activities carried out 
                under the grant; and
                    (B) develop models for the replication of 
                successful programs and activities and the mentoring of 
                other eligible entities.
    (d) Training.--
            (1) In general.--The Director shall develop a program to 
        provide training for eligible entities on effective strategies 
        for the prevention and control of chronic disease
            (2) Community transformation plan.--The Director shall 
        provide appropriate feedback and technical assistance to 
        grantees to establish community transformation plans
            (3) Evaluation.--The Director shall provide a literature 
        review and framework for the evaluation of programs conducted 
        as part of the grant program under this section, in addition to 
        working with academic institutions or other entities with 
        expertise in outcome evaluation.
    (e) Prohibition.--A grantee shall not use funds provided under a 
grant under this section to create video games or to carry out any 
other activities that may lead to higher rates of obesity or 
inactivity.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each fiscal years 2010 through 2014.

SEC. 322. HEALTHY AGING, LIVING WELL.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), acting through the 
Director of the Centers for Disease Control and Prevention, shall award 
grants to State or local health departments and Indian tribes to carry 
out 5-year pilot programs to provide public health community 
interventions, screenings, and where necessary, clinical referrals for 
individuals who are between 55 and 64 years of age.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            (1) be--
                    (A) a State health department;
                    (B) a local health department; or
                    (C) an Indian tribe;
            (2) submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary 
        may require including a description of the program to be 
        carried out under the grant;
            (3) design a strategy for improving the health of the 55-
        to-64 year-old population through community-based public health 
        interventions; and
            (4) demonstrate the capacity, if funded, to develop the 
        relationships necessary with relevant health agencies, health 
        care providers, community-based organizations, and insurers to 
        carry out the activities described in subsection (c), such 
        relationships to include the identification of a community-
        based clinical partner, such as a community health center or 
        rural health clinic.
    (c) Use of Funds.--
            (1) In general.--A State or local health department shall 
        use amounts received under a grant under this section to carry 
        out a program to provide the services described in this 
        subsection to individuals who are between 55 and 64 years of 
        age.
            (2) Public health interventions.--
                    (A) In general.--In developing and implementing 
                such activities, a grantee shall collaborate with the 
                Centers for Disease Control and Prevention and the 
                Administration on Aging, and relevant local agencies 
                and organizations.
                    (B) Types of intervention activities.--Intervention 
                activities conducted under this paragraph may include 
                efforts to improve nutrition, increase physical 
                activity, reduce tobacco use and substance abuse, 
                improve mental health, and promote healthy lifestyles 
                among the target population.
            (3) Community preventive screenings.--
                    (A) In general.--In addition to community-wide 
                public health interventions, a State or local health 
                department shall use amounts received under a grant 
                under this section to conduct ongoing health screening 
                to identify risk factors for cardiovascular disease, 
                stroke, and diabetes among individuals who are between 
                55 and 64 years of age.
                    (B) Types of screening activities.--Screening 
                activities conducted under this paragraph may include--
                            (i) mental health/behavioral health and 
                        substance use disorders;
                            (ii) physical activity, smoking, and 
                        nutrition; and
                            (iii) any other measures deemed appropriate 
                        by the Secretary.
                    (C) Monitoring.--Grantees under this section shall 
                maintain records of screening results under this 
                paragraph to establish the baseline data for monitoring 
                the targeted population
            (4) Clinical referral/treatment for chronic diseases.--
                    (A) In general.--A State or local health department 
                shall use amounts received under a grant under this 
                section to ensure that individuals between 55 and 64 
                years of age who are found to have chronic disease risk 
                factors through the screening activities described in 
                paragraph (3)(B), receive clinical referral/treatment 
                for follow-up services to reduce such risk.
                    (B) Mechanism.--
                            (i) Identification and determination of 
                        status.--With respect to each individual with 
                        risk factors for or having heart disease, 
                        stroke, diabetes, or any other condition for 
                        which such individual was screened under 
                        paragraph (3), a grantee under this section 
                        shall determine whether or not such individual 
                        is covered under any public or private health 
                        insurance program.
                            (ii) Insured individuals.--An individual 
                        determined to be covered under a health 
                        insurance program under clause (i) shall be 
                        referred by the grantee to the existing 
                        providers under such program or, if such 
                        individual does not have a current provider, to 
                        a provider who is in-network with respect to 
                        the program involved.
                            (iii) Uninsured individuals.--With respect 
                        to an individual determined to be uninsured 
                        under clause (i), the grantee's community-based 
                        clinical partner described in subsection (b)(4) 
                        shall assist the individual in determining 
                        eligibility for available public coverage 
                        options and identify other appropriate 
                        community health care resources and assistance 
                        programs.
                    (C) Public health intervention program.--A State or 
                local health department shall use amounts received 
                under a grant under this section to enter into 
                contracts with community health centers or rural health 
                clinics and mental health and substance use disorder 
                service providers to assist in the referral/treatment 
                of at risk patients to community resources for clinical 
                follow-up and help determine eligibility for other 
                public programs.
            (5) Grantee evaluation.--An eligible entity shall use 
        amounts provided under a grant under this section to conduct 
        activities to measure changes in the prevalence of chronic 
        disease risk factors among participants.
    (d) Pilot Program Evaluation.--The Secretary shall conduct an 
annual evaluation of the effectiveness of the pilot program under this 
section. In determining such effectiveness, the Secretary shall 
consider changes in the prevalence of uncontrolled chronic disease risk 
factors among new Medicare enrollees (or individuals nearing 
enrollment, including those who are 63 and 64 years of age) who reside 
in States or localities receiving grants under this section as compared 
with national and historical data for those States and localities for 
the same population.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2014.

SEC. 323. WELLNESS FOR INDIVIDUALS WITH DISABILITIES.

    Title V of the Rehabilitation Act of 1973 (29 U.S.C. 791 et seq.) 
is amended by adding at the end of the following:

``SEC. 510. ESTABLISHMENT OF STANDARDS FOR ACCESSIBLE MEDICAL 
              DIAGNOSTIC EQUIPMENT.

    ``(a) Standards.--Not later than 24 months after the date of 
enactment of the Affordable Health Choices Act, the Architectural and 
Transportation Barriers Compliance Board shall, in consultation with 
the Commissioner of the Food and Drug Administration, promulgate 
regulatory standards in accordance with the Administrative Procedure 
Act (2 U.S.C. 551 et seq.) setting forth the minimum technical criteria 
for medical diagnostic equipment used in (or in conjunction with) 
physician's offices, clinics, emergency rooms, hospitals, and other 
medical settings. The standards shall ensure that such equipment is 
accessible to, and usable by, individuals with accessibility needs, and 
shall allow independent entry to, use of, and exit from the equipment 
by such individuals to the maximum extent possible.
    ``(b) Medical Diagnostic Equipment Covered.--The standards issued 
under subsection (a) for medical diagnostic equipment shall apply to 
equipment that includes examination tables, examination chairs 
(including chairs used for eye examinations or procedures, and dental 
examinations or procedures), weight scales, mammography equipment, x-
ray machines, and other radiological equipment commonly used for 
diagnostic purposes by health professionals.
    ``(c) Review and Amendment.--The Architectural and Transportation 
Barriers Compliance Board, in consultation with the Commissioner of the 
Food and Drug Administration, shall periodically review and, as 
appropriate, amend the standards in accordance with the Administrative 
Procedure Act (2 U.S.C. 551 et seq.).''.

SEC. 324. IMMUNIZATIONS.

    (a) State Authority to Purchase Recommended Vaccines for Adults.--
Section 317 of the Public Health Service Act (42 U.S.C. 247b) is 
amended by adding at the end the following:
    ``(l) Authority to Purchase Recommended Vaccines for Adults.--
            ``(1) In general.--The Secretary may negotiate and enter 
        into contracts with manufacturers of vaccines for the purchase 
        and delivery of vaccines for adults as provided for under 
        subsection (e).
            ``(2) State purchase.--A State may obtain additional 
        quantities of such adult vaccines (subject to amounts specified 
        to the Secretary by the State in advance of negotiations) 
        through the purchase of vaccines from manufacturers at the 
        applicable price negotiated by the Secretary under this 
        subsection.''.
    (b) Demonstration Program to Improve Immunization Coverage.--
Section 317 of the Public Health Service Act (42 U.S.C. 247b), as 
amended by subsection (a), is further amended by adding at the end the 
following:
    ``(m) Demonstration Program to Improve Immunization Coverage.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall establish a demonstration program to award grants to 
        States to improve the provision of recommended immunizations 
        for children, adolescents, and adults through the use of 
        evidence-based, population-based interventions for high-risk 
        populations.
            ``(2) State plan.--To be eligible for a grant under 
        paragraph (1), a State shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require, including a State 
        plan that describes the interventions to be implemented under 
        the grant and how such interventions match with local needs and 
        capabilities, as determined through consultation with local 
        authorities.
            ``(3) Use of funds.--Funds received under a grant under 
        this subsection shall be used to implement interventions that 
        are recommended by the Task Force on Community Preventive 
        Services (as established by the Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention) or 
        other evidence-based interventions, including--
                    ``(A) providing immunization reminders or recalls 
                for target populations of clients, patients, and 
                consumers;
                    ``(B) educating targeted populations and health 
                care providers concerning immunizations in combination 
                with one or more other interventions;
                    ``(C) reducing out-of-pocket costs for families for 
                vaccines and their administration;
                    ``(D) carrying out immunization-promoting 
                strategies for participants or clients of public 
                programs, including assessments of immunization status, 
                referrals to health care providers, education, 
                provision of on-site immunizations, or incentives for 
                immunization;
                    ``(E) providing for home visits that promote 
                immunization through education, assessments of need, 
                referrals, provision of immunizations, or other 
                services;
                    ``(F) providing reminders or recalls for 
                immunization providers;
                    ``(G) conducting assessments of, and providing 
                feedback to, immunization providers;
                    ``(H) any combination of one or more interventions 
                described in this paragraph; or
                    ``(I) immunization information systems to allow all 
                States to have electronic databases for immunization 
                records.
            ``(4) Consideration.--In awarding grants under this 
        subsection, the Secretary shall consider any reviews or 
        recommendations of the Task Force on Community Preventive 
        Services.
            ``(5) Evaluation.--Not later than 3 years after the date on 
        which a State receives a grant under this subsection, the State 
        shall submit to the Secretary an evaluation of progress made 
        toward improving immunization coverage rates among high-risk 
        populations within the State.
            ``(6) Report to congress.--Not later than 4 years after the 
        date of enactment of the Affordable Health Choices Act, the 
        Secretary shall submit to Congress a report concerning the 
        effectiveness of the demonstration program established under 
        this subsection together with recommendations on whether to 
        continue and expand such program.
            ``(7) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, such sums as 
        may be necessary for each of fiscal years 2010 through 2014.''.
    (c) Reauthorization of Immunization Program.--Section 317(j) of the 
Public Health Service Act (42 U.S.C. 247b(j)) is amended--
            (1) in paragraph (1), by striking ``for each of the fiscal 
        years 1998 through 2005''; and
            (2) in paragraph (2), by striking ``after October 1, 
        1997,''.
    (d) Rule of Construction Regarding Access to Immunizations.--
Nothing in this section (including the amendments made by this 
section), or any other provision of this Act (including any amendments 
made by this Act) shall be construed to decrease children's access to 
immunizations.

SEC. 325. NUTRITION LABELING OF STANDARD MENU ITEMS AT CHAIN 
              RESTAURANTS AND OF ARTICLES OF FOOD SOLD FROM VENDING 
              MACHINES.

    (a) Technical Amendments.--Section 403(q)(5)(A) of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)(A)) is amended--
            (1) in subitem (i), by inserting at the beginning ``except 
        as provided in clause (H)(ii)(III),''; and
            (2) in subitem (ii), by inserting at the beginning ``except 
        as provided in clause (H)(ii)(III),''.
    (b) Labeling Requirements.--Section 403(q)(5) of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)) is amended by adding at 
the end the following:
    ``(H) Restaurants, Retail Food Establishments, and Vending 
Machines.--
            ``(i) General requirements for restaurants and similar 
        retail food establishments.--Except for food described in 
        subclause (vii), in the case of food that is a standard menu 
        item that is offered for sale in a restaurant or similar retail 
        food establishment that is part of a chain with 20 or more 
        locations doing business under the same name (regardless of the 
        type of ownership of the locations) and offering for sale 
        substantially the same menu items, the restaurant or similar 
        retail food establishment shall disclose the information 
        described in subclauses (ii) and (iii).
            ``(ii) Information required to be disclosed by restaurants 
        and retail food establishments.--Except as provided in 
        subclause (vii), the restaurant or similar retail food 
        establishment shall disclose in a clear and conspicuous 
        manner--
                    ``(I)(aa) in a nutrient content disclosure 
                statement adjacent to the name of the standard menu 
                item, so as to be clearly associated with the standard 
                menu item, on the menu listing the item for sale, the 
                number of calories contained in the standard menu item, 
                as usually prepared and offered for sale; and
                    ``(bb) a succinct statement concerning suggested 
                daily caloric intake, as specified by the Secretary by 
                regulation and posted prominently on the menu and 
                designed to enable the public to understand, in the 
                context of a total daily diet, the significance of the 
                caloric information that is provided on the menu;
                    ``(II)(aa) in a nutrient content disclosure 
                statement adjacent to the name of the standard menu 
                item, so as to be clearly associated with the standard 
                menu item, on the menu board, including a drive-through 
                menu board, the number of calories contained in the 
                standard menu item, as usually prepared and offered for 
                sale; and
                    ``(bb) a succinct statement concerning suggested 
                daily caloric intake, as specified by the Secretary by 
                regulation and posted prominently on the menu board, 
                designed to enable the public to understand, in the 
                context of a total daily diet, the significance of the 
                nutrition information that is provided on the menu 
                board;
            ``(III) in a written form, available on the premises of the 
        restaurant or similar retail establishment and to the consumer 
        upon request, the nutrition information required under clauses 
        (C) and (D) of subparagraph (1); and
            ``(IV) on the menu or menu board, a prominent, clear, and 
        conspicuous statement regarding the availability of the 
        information described in item (III).
            ``(iii) Self-service food and food on display.--Except as 
        provided in subclause (vii), in the case of food sold at a 
        salad bar, buffet line, cafeteria line, or similar self-service 
        facility, and for self-service beverages or food that is on 
        display and that is visible to customers, a restaurant or 
        similar retail food establishment shall place adjacent to each 
        food offered a sign that lists calories per displayed food item 
        or per serving.
            ``(iv) Reasonable basis.--For the purposes of this clause, 
        a restaurant or similar retail food establishment shall have a 
        reasonable basis for its nutrient content disclosures, 
        including nutrient databases, cookbooks, laboratory analyses, 
        and other reasonable means, as described in section 101.10 of 
        title 21, Code of Federal Regulations (or any successor 
        regulation) or in a related guidance of the Food and Drug 
        Administration.
            ``(v) Menu variability and combination meals.--The 
        Secretary shall establish by regulation standards for 
        determining and disclosing the nutrient content for standard 
        menu items that come in different flavors, varieties, or 
        combinations, but which are listed as a single menu item, such 
        as soft drinks, ice cream, pizza, doughnuts, or children's 
        combination meals, through means determined by the Secretary, 
        including ranges, averages, or other methods.
            ``(vi) Additional information.--If the Secretary determines 
        that a nutrient, other than a nutrient required under subclause 
        (ii)(III), should be disclosed for the purpose of providing 
        information to assist consumers in maintaining healthy dietary 
        practices, the Secretary may require, by regulation, disclosure 
        of such nutrient in the written form required under subclause 
        (ii)(III).
            ``(vii) Nonapplicability to certain food.--
                    ``(I) In general.--Subclauses (i) through (vi) do 
                not apply to--
                            ``(aa) items that are not listed on a menu 
                        or menu board (such as condiments and other 
                        items placed on the table or counter for 
                        general use);
                            ``(bb) daily specials, temporary menu items 
                        appearing on the menu for less than 60 days per 
                        calendar year, or custom orders; or
                            ``(cc) such other food that is part of a 
                        customary market test appearing on the menu for 
                        less than 90 days, under terms and conditions 
                        established by the Secretary.
                    ``(II) Written forms.--Subparagraph (5)(C) shall 
                apply to any regulations promulgated under subclauses 
                (ii)(III) and (vi).
            ``(viii) Vending machines.--
                    ``(I) In general.--In the case of an article of 
                food sold from a vending machine that--
                            ``(aa) does not permit a prospective 
                        purchaser to examine the Nutrition Facts Panel 
                        before purchasing the article or does not 
                        otherwise provide visible nutrition information 
                        at the point of purchase; and
                            ``(bb) is operated by a person who is 
                        engaged in the business of owning or operating 
                        20 or more vending machines,
                the vending machine operator shall provide a sign in 
                close proximity to each article of food or the 
                selection button that includes a clear and conspicuous 
                statement disclosing the number of calories contained 
                in the article.
            ``(ix) Voluntary provision of nutrition information.--
                    ``(I) In general.--An authorized official of any 
                restaurant or similar retail food establishment or 
                vending machine operator not subject to the 
                requirements of this clause may elect to be subject to 
                the requirements of such clause, by registering 
                biannually the name and address of such restaurant or 
                similar retail food establishment or vending machine 
                operator with the Secretary, as specified by the 
                Secretary by regulation.
                    ``(II) Registration.--Within 120 days of enactment 
                of this clause, the Secretary shall publish a notice in 
                the Federal Register specifying the terms and 
                conditions for implementation of item (I), pending 
                promulgation of regulations.
                    ``(III) Rule of construction.--Nothing in this 
                subclause shall be construed to authorize the Secretary 
                to require an application, review, or licensing process 
                for any entity to register with the Secretary, as 
                described in such item.
            ``(x) Regulations.--
                    ``(I) Proposed regulation.--Not later than 1 year 
                after the date of enactment of this clause, the 
                Secretary shall promulgate proposed regulations to 
                carry out this clause.
                    ``(II) Contents.--In promulgating regulations, the 
                Secretary shall--
                            ``(aa) consider standardization of recipes 
                        and methods of preparation, reasonable 
                        variation in serving size and formulation of 
                        menu items, space on menus and menu boards, 
                        inadvertent human error, training of food 
                        service workers, variations in ingredients, and 
                        other factors, as the Secretary determines; and
                            ``(bb) specify the format and manner of the 
                        nutrient content disclosure requirements under 
                        this subclause.
                    ``(III) Reporting.--The Secretary shall submit to 
                the Committee on Health, Education, Labor, and Pensions 
                of the Senate and the Committee on Energy and Commerce 
                of the House of Representatives a quarterly report that 
                describes the Secretary's progress toward promulgating 
                final regulations under this subparagraph.
            ``(xi) Definition.--In this clause, the term `menu' or 
        `menu board' means the primary writing of the restaurant or 
        other similar retail food establishment from which a consumer 
        makes an order selection.''
    (c) National Uniformity.--Section 403A(a)(4) of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 343-1(a)(4)) is amended by striking 
``except a requirement for nutrition labeling of food which is exempt 
under subclause (i) or (ii) of section 403(q)(5)(A)'' and inserting 
``except that this paragraph does not apply to food that is offered for 
sale in a restaurant or similar retail food establishment that is not 
part of a chain with 20 or more locations doing business under the same 
name (regardless of the type of ownership of the locations) and 
offering for sale substantially the same menu items unless such 
restaurant or similar retail food establishment complies with the 
voluntary provision of nutrition information requirements under section 
403(q)(5)(H)(ix)''.
    (d) Rule of Construction.--Nothing in the amendments made by this 
section shall be construed--
            (1) to preempt any provision of State or local law, unless 
        such provision establishes or continues into effect nutrient 
        content disclosures of the type required under section 
        403(q)(5)(H) of the Federal Food, Drug, and Cosmetic Act (as 
        added by subsection (b)) and is expressly preempted under 
        subsection (a)(4) of such section;
            (2) to apply to any State or local requirement respecting a 
        statement in the labeling of food that provides for a warning 
        concerning the safety of the food or component of the food; or
            (3) except as provided in section 403(q)(5)(H)(ix) of the 
        Federal Food, Drug, and Cosmetic Act (as added by subsection 
        (b)), to apply to any restaurant or similar retail food 
        establishment other than a restaurant or similar retail food 
        establishment described in section 403(q)(5)(H)(i) of such Act.

SEC. 326. ENCOURAGING EMPLOYER-SPONSORED WELLNESS PROGRAMS.

    A group health plan and a health insurance issuer offering health 
insurance coverage in connection with a group health plan may offer 
incentives to an individual who voluntarily participates in a wellness 
program that is reasonably-designed to promote health or prevent 
disease. Nothing in this Act (or an amendment made by this Act) shall 
be construed to limit the ability of a group health plan or health 
insurance issuer, under regulations in effect on the date of enactment 
of this Act, to offer participants variations in employee contributions 
towards the cost of coverage for participation in wellness programs.

SEC. 327. DEMONSTRATION PROJECT CONCERNING INDIVIDUALIZED WELLNESS 
              PLAN.

    Section 330 of the Public Health Service Act (42 U.S.C. 245b) is 
amended by adding at the end the following:
    ``(s) Pilot Program for Individualized Wellness Plans.--
            ``(1) In general.--The Secretary shall establish a pilot 
        program to test the impact of providing at-risk populations who 
        utilize community health centers funded under this section an 
        individualized wellness plan that is designed to reduce risk 
        factors for preventable conditions as identified by a 
        comprehensive risk-factor assessment.
            ``(2) Agreements.--The Secretary shall enter into 
        agreements with not more than 10 community health centers 
        funded under this section to conduct activities under the pilot 
        program under paragraph (1).
            ``(3) Wellness plans.--
                    ``(A) In general.--An individualized wellness plan 
                prepared under the pilot program under this subsection 
                may include one or more of the following as appropriate 
                to the individual's identified risk factors:
                            ``(i) Nutritional counseling.
                            ``(ii) A physical activity plan.
                            ``(iii) Alcohol and smoking cessation 
                        counseling and services.
                            ``(iv) Stress management.
                            ``(v) Dietary supplements that have health 
                        claims approved by the Secretary.
                            ``(vi) Compliance assistance provided by a 
                        community health center employee.
                    ``(B) Risk factors.--Wellness plan risk factors 
                shall include--
                            ``(i) weight;
                            ``(ii) tobacco and alcohol use;
                            ``(iii) exercise rates;
                            ``(iv) nutritional status; and
                            ``(v) blood pressure.
                    ``(C) Comparisons.--Individualized wellness plans 
                shall make comparisons between the individual involved 
                and a control group of individuals with respect to the 
                risk factors described in subparagraph (B).
            ``(4) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, such sums as 
        may be necessary.''.

SEC. 328. REASONABLE BREAK TIME FOR NURSING MOTHERS.

    Section 7 of the Fair Labor Standards Act of 1938 (29 U.S.C. 207) 
is amended by adding at the end the following:
    ``(r)(1) An employer shall provide--
            ``(A) a reasonable break time for an employee to express 
        breast milk for her nursing child for 1 year after the child's 
        birth each time such employee has need to express the milk; and
            ``(B) a place, other than a bathroom, that is shielded from 
        view and free from intrusion from coworkers and the public, 
        which may be used by an employee to express breast milk.
    ``(2) An employer shall not be required to compensate an employee 
receiving reasonable break time under paragraph (1) for any work time 
spent for such purpose.
    ``(3) An employer that employs less than 50 employees shall not be 
subject to the requirements of this subsection, if such requirements 
would impose an undue hardship by causing the employer significant 
difficulty or expense when considered in relation to the size, 
financial resources, nature, or structure of the employer's 
business.''.

    Subtitle D--Support for Prevention and Public Health Innovation

SEC. 331. RESEARCH ON OPTIMIZING THE DELIVERY OF PUBLIC HEALTH 
              SERVICES.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), acting through the 
Director of the Centers for Disease Control and Prevention, shall 
provide funding for research in the area of public health services and 
systems.
    (b) Requirements of Research.--Research supported under this 
section shall include--
            (1) examining evidence-based practices relating to 
        prevention, with a particular focus on high priority areas as 
        identified by the Secretary in the National Prevention Strategy 
        or Healthy People 2020, and including comparing community-based 
        public health interventions in terms of effectiveness and cost;
            (2) analyzing the translation of interventions from 
        academic settings to real world settings; and
            (3) identifying effective strategies for organizing, 
        financing, or delivering public health services in real world 
        community settings, including comparing State and local health 
        department structures and systems in terms of effectiveness and 
        cost.
    (c) Existing Partnerships.--Research supported under this section 
shall be coordinated with the Community Preventive Services Task Force 
and carried out by building on existing partnerships within the Federal 
Government while also considering initiatives at the State and local 
levels and in the private sector.
    (d) Annual Report.--The Secretary shall, on an annual basis, submit 
to Congress a report concerning the activities and findings with 
respect to research supported under this section.

SEC. 332. UNDERSTANDING HEALTH DISPARITIES: DATA COLLECTION AND 
              ANALYSIS.

    The Public Health Service Act (42 U.S.C. 201 et seq.) as amended by 
section 172, is further amended by adding at the end the following:

         ``TITLE XXXIII--DATA COLLECTION, ANALYSIS, AND QUALITY

``SEC. 3301. DATA COLLECTION, ANALYSIS, AND QUALITY.

    ``(a) Data Collection.--
            ``(1) In general.--The Secretary shall ensure that, by not 
        later than 1 year after the date of enactment of this title, 
        any ongoing or federally conducted or supported health care or 
        public health program, activity or survey collects and 
        reports--
                    ``(A) data on race and ethnicity for applicants, 
                recipients, or beneficiaries;
                    ``(B) data on gender, geographic location, 
                socioeconomic status (including education, employment 
                or income), primary language, and, disability status 
                data for applicants, recipients, or beneficiaries;
                    ``(C) data at the smallest geographic level such as 
                State, local, or institutional levels if such data can 
                be aggregated;
                    ``(D) if practicable, data by racial and ethnic 
                subgroups for applicants, recipients or beneficiaries 
                using, if needed, statistical oversamples of these 
                subpopulations; and
                    ``(E) any other demographic data as deemed 
                appropriate by the Secretary regarding health 
                disparities.
            ``(2) Collection standards.--In collecting data described 
        in paragraph (1), the Secretary or designee shall--
                    ``(A) use Office of Management and Budget 
                standards, at a minimum, for race and ethnicity 
                measures;
                    ``(B) develop standards for the measurement of 
                gender, geographic location, socioeconomic status, 
                primary language and disability measures; and
                    ``(C) develop standards for the collection of data 
                described in paragraph (1) that, at a minimum--
                            ``(i) collects self-reported data by the 
                        applicant, recipient, or beneficiary; and
                            ``(ii) collects data from a parent or legal 
                        guardian if the applicant, recipient, or 
                        beneficiary is a minor or legally 
                        incapacitated.
            ``(3) Data management.--In collecting data described in 
        paragraph (1), the Secretary, acting through the National 
        Coordinator for Health Information Technology shall--
                    ``(A) develop national standards for the management 
                of data collected; and
                    ``(B) develop interoperability and security systems 
                for data management.
    ``(b) Data Analysis.--
            ``(1) In general.--For each federally conducted or 
        supported health care or public health program or activity, the 
        Secretary shall analyze data collected under paragraph (a) to 
        detect and monitor trends in health disparities (as defined in 
        section 485E) at the Federal and State levels.
    ``(c) Data Reporting and Dissemination.--
            ``(1) In general.--The Secretary shall make the analyses 
        described in (b) available to--
                    ``(A) the Office of Minority Health;
                    ``(B) the National Center on Minority Health and 
                Health Disparities;
                    ``(C) the Agency for Healthcare Research and 
                Quality;
                    ``(D) the Centers for Disease Control and 
                Prevention;
                    ``(E) the Centers for Medicare & Medicaid Services;
                    ``(F) the Indian Health Service and epidemiology 
                centers funded under the Indian Health Care Improvement 
                Act;
                    ``(G) other agencies within the Department of 
                Health and Human Services; and
                    ``(H) other entities as determined appropriate by 
                the Secretary.
            ``(2) Reporting of data.--The Secretary shall report data 
        and analyses described in (a) and (b) through--
                    ``(A) public postings on the Internet websites of 
                the Department of Health and Human Services; and
                    ``(B) any other reporting or dissemination 
                mechanisms determined appropriate by the Secretary.
            ``(3) Availability of data.--The Secretary may make data 
        described in (a) and (b) available for additional research, 
        analyses, and dissemination to other Federal agencies, non-
        governmental entities, and the public.
    ``(d) Limitations on Use of Data.--Nothing in this section shall be 
construed to permit the use of information collected under this section 
in a manner that would adversely affect any individual.
    ``(e) Protection of Data.--The Secretary shall ensure (through the 
promulgation of regulations or otherwise) that all data collected 
pursuant to subsection (a) is protected--
            ``(1) under the same privacy protections that are at least 
        as broad as those that the Secretary applies to other health 
        data under the regulations promulgated under section 264(c) of 
        the Health Insurance Portability and Accountability Act of 1996 
        (Public Law 104-191; 110 Stat. 2033); and
            ``(2) from all inappropriate internal use by any entity 
        that collects, stores, or receives the data, including use of 
        such data in determinations of eligibility (or continued 
        eligibility) in health plans, and from other inappropriate 
        uses, as defined by the Secretary.
    ``(f) Data on Rural Underserved Populations.--The Secretary shall 
ensure that any data collected in accordance with this section 
regarding racial and ethnic minority groups is also collected regarding 
underserved rural and frontier populations.
    ``(g) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of fiscal years 2010 through 2014.
    ``(h) Requirement for Implementation.--Notwithstanding any other 
provision of this section, data may not be collected under this section 
unless funds are directly appropriated for such purpose in an 
appropriations Act.''.

SEC. 333. HEALTH IMPACT ASSESSMENTS.

    (a) Purpose.--It is the purpose of this section to determine if the 
built environment has an impact on health.
    (b) Definition.--In this section:
            (1) Administrator.--The term ``Administrator'' means the 
        Administrator of the Environmental Protection Agency.
            (2) Built environment.--The term ``built environment'' 
        means an environment consisting of building, spaces, and 
        products that are created or modified by individuals and 
        entities, including homes, schools, workplaces, greenways, 
        business areas, transportation systems, and parks and 
        recreation areas, electrical transmission lines, waste disposal 
        sites, and land-use planning and policies that impact urban, 
        rural and suburban communities.
            (3) Director.--The term ``Director'' means the Director of 
        the Centers for Disease Control and Prevention.
            (4) Environmental health.--The term ``environmental 
        health'' means the health and wellbeing of a population as 
        affected by the direct pathological effects of chemicals, 
        radiation or biological agents, and the effects, including the 
        indirect effects, of the broad physical, psychological, social 
        and aesthetic environment.
            (5) Health impact assessment.--The term ``health impact 
        assessment'' means a combination of procedures, methods, and 
        tools by which a regulation, program, or other project is 
        assessed as to its potential effects on the health of a 
        population, and the distribution of those effects within the 
        population.
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (c) Fostering Health Impact Assessment.--
            (1) Establishment.--The Secretary, acting through the 
        Director and in coordination with the Administrator, shall 
        establish a program at the National Center of Environmental 
        Health at the Centers for Disease Control and Prevention to 
        foster advances and provide technical support in the field of 
        health impact assessments.
            (2) Activities.--Through the program under paragraph (1), 
        the Secretary shall--
                    (A) collect and disseminate evidence-based 
                practices relating to health impact assessments;
                    (B) manage capacity building grants, technical 
                assistance, and training on the use of health impact 
                assessments; and
                    (C) provide guidance on health impact assessments 
                including similar international efforts, known 
                associations between the built environment and health 
                outcomes, forecasting of potential health effects of 
                the built environment, and best practices relating to 
                the inclusion of the public in planning processes.

SEC. 334. CDC AND EMPLOYER-BASED WELLNESS PROGRAMS.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), 
as amended by section 314) is further amended by adding at the end the 
following:

               ``PART T--EMPLOYER-BASED WELLNESS PROGRAM

``SEC. 399HH. WORKPLACE WELLNESS MARKETING CAMPAIGN.

    ``Subject to appropriations Acts, the Director of the Centers for 
Disease Control and Prevention (referred to in this section as the 
`Director'), in coordination with relevant worksite health promotion 
organizations, State and local health departments, the Indian Health 
Service, Indian tribes and tribal organizations, and academic 
institutions, shall conduct targeted educational campaigns to--
            ``(1) make employers, employer groups, and other interested 
        parties aware of the benefits of employer-based wellness 
        programs;
            ``(2) establish a culture of health by emphasizing health 
        promotion and disease prevention;
            ``(3) emphasize an integrated and coordinated approach to 
        workplace wellness; and
            ``(4) ensure informed decisions through high quality 
        information to organizational leaders.

``SEC. 399HH-1. TECHNICAL ASSISTANCE FOR EMPLOYER-BASED WELLNESS 
              PROGRAMS.

    ``In order to expand the utilization of evidence-based prevention 
and health promotion approaches in the workplace, the Director shall--
            ``(1) provide employers (including small, medium, and large 
        employers, as determined by the Director) with technical 
        assistance, consultation, tools, and other resources in 
        evaluating such employers' employer-based wellness programs, 
        including--
                    ``(A) measuring the participation and methods to 
                increase participation of employees in such programs;
                    ``(B) developing standardized measures that assess 
                policy, environmental and systems changes necessary to 
                have a positive health impact on employees' health 
                behaviors, health outcomes, and health care 
                expenditures; and
                    ``(C) evaluating such programs as they relate to 
                changes in the health status of employees, the 
                absenteeism of employees, the productivity of 
                employees, the rate of workplace injury, and the 
                medical costs incurred by employees; and
            ``(2) build evaluation capacity among workplace staff by 
        training employers on how to evaluate employer-based wellness 
        programs by ensuring evaluation resources, technical 
        assistance, and consultation are available to workplace staff 
        as needed through such mechanisms as web portals, call centers, 
        or other means.

``SEC. 399HH-2. NATIONAL WORKSITE HEALTH POLICIES AND PROGRAMS STUDY.

    ``(a) In General.--In order to assess, analyze, and monitor over 
time data about workplace policies and programs, and to develop 
instruments to assess and evaluate comprehensive workplace chronic 
disease prevention and health promotion programs, policies and 
practices, not later than 2 years after the date of enactment of this 
part, and at regular intervals (to be determined by the Director) 
thereafter, the Director shall conduct a national worksite health 
policies and programs survey to assess employer-based health policies 
and programs.
    ``(b) Report.--Upon the completion of each study under subsection 
(a), the Director shall submit to Congress a report that includes the 
recommendations of the Director for the implementation of effective 
employer-based health policies and programs.

``SEC. 399HH-3. RESEARCH IN WORKPLACE WELLNESS.

    ``(a) Workplace Demonstration Studies.--To expand the science base 
for effective prevention and health promotion approaches in the 
workplace, the Director, in collaboration with academic institutions 
and employers, shall institute workplace demonstration projects across 
small, medium, and large employers. Such demonstration projects shall 
be designed to determine how best to transform the work environment for 
health, safety, and wellness, how to create a strong, sustainable, 
coordinated, and integrated workplace health promotion and wellness 
program, and how to create innovative and sustainable policy and 
environmental strategies to improve employee health and wellness.
    ``(b) Report.--Upon the completion of the study under subsection 
(b), the Director shall submit to Congress a report that includes the 
recommendations of the Director for the implementation of effective 
employer-based health policies and programs.

``SEC. 399HH-4. PRIORITIZATION OF EVALUATION BY SECRETARY.

    ``The Secretary shall evaluate, in accordance with this part, all 
programs funded through the Centers for Disease Control and Prevention 
before conducting such an evaluation of privately funded programs 
unless an entity with a privately funded wellness program requests such 
an evaluation.

``SEC. 399HH-5. PROHIBITION OF FEDERAL WORKPLACE WELLNESS REQUIREMENTS.

    ``Notwithstanding any other provision of this part, any 
recommendations, data, or assessments carried out under this part shall 
not be used to mandate requirements for workplace wellness programs.''.

SEC. 335. EPIDEMIOLOGY-LABORATORY CAPACITY GRANTS.

    Title XXVIII of the Public Health Service Act (42 U.S.C. 300hh et 
seq.) is amended by adding at the end the following:

     ``Subtitle C--Strengthening Public Health Surveillance Systems

``SEC. 2821. EPIDEMIOLOGY-LABORATORY CAPACITY GRANTS.

    ``(a) In General.--Subject to the availability of appropriations, 
the Secretary, acting through the Director of the Centers for Disease 
Control and Prevention, shall establish an Epidemiology and Laboratory 
Capacity Grant Program to award grants to eligible entities to assist 
public health agencies in improving surveillance for, and response to, 
infectious diseases and other conditions of public health importance 
by--
            ``(1) strengthening epidemiologic capacity;
            ``(2) enhancing laboratory practice;
            ``(3) improving information systems; and
            ``(4) developing and implementing prevention and control 
        strategies.
    ``(b) Eligible Entities.--In this section, the term `eligible 
entity' means an entity that--
            ``(1) is--
                    ``(A) a State health department;
                    ``(B) a local health department that meets such 
                criteria as the Director of the Centers for Diseases 
                Control and Prevention determines for purposes of this 
                section;
                    ``(C) a tribal jurisdiction that meets such 
                criteria as the Director of the Centers for Disease 
                Control and Prevention determines for purposes of this 
                section; or
                    ``(D) a partnership established for purposes of 
                this section between one or more eligible entities 
                described in subparagraph (A), (B), or (C) and an 
                academic center; and
            ``(2) submits to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--
            ``(1) In general.--An eligible entity shall use amounts 
        received under a grant under this section for core functions 
        described in this subsection including--
                    ``(A) building public health capacity to identify 
                and monitor the occurrence of infectious diseases and 
                other conditions of public health importance;
                    ``(B) detecting new and emerging infectious disease 
                threats, including laboratory capacity to detect 
                antimicrobial resistant infections;
                    ``(C) identifying and responding to disease 
                outbreaks;
                    ``(D) hiring necessary staff;
                    ``(E) conducting needed staff training and 
                educational development; and
                    ``(F) other activities that improve surveillance as 
                determined by the Director of the Centers for Disease 
                Control and Prevention.
            ``(2) Development and maintenance of information 
        exchange.--
                    ``(A) National standards.--Not later than 180 days 
                after the date of the enactment of this subtitle, the 
                Secretary, acting through the Director of the Centers 
                for Disease Control and Prevention, and in consultation 
                with the National Coordinator for Health Information 
                Technology, shall issue guidelines for public health 
                entities that--
                            ``(i) are designed to ensure that all State 
                        and local health departments and public health 
                        laboratories have access to information systems 
                        to receive, monitor, and report infectious 
                        diseases and other urgent conditions of public 
                        health importance; and
                            ``(ii) are consistent with standards and 
                        recommendations for health information 
                        technology by the National Coordinator for 
                        Health Information Technology, and by the 
                        American Health Information Community (AHIC) 
                        and its successors.
                    ``(B) Secure information systems.--An eligible 
                entity shall use amounts received through a grant under 
                this section to ensure that the entity has access to a 
                web-based, secure information system that complies with 
                the guidelines developed under subparagraph (A). Such a 
                system shall be designed--
                            ``(i) to receive automated case reports of 
                        State and national reportable conditions from 
                        clinical systems and health care offices that 
                        use electronic health records and from clinical 
                        and public health laboratories, and to submit 
                        reports of nationally reportable conditions to 
                        the Director of the Centers for Disease Control 
                        and Prevention;
                            ``(ii) to receive and analyze, within 24 
                        hours, de-identified electronic clinical data 
                        for situational awareness and to forward such 
                        reports immediately to the Centers for Disease 
                        Control and Prevention at the time of receipt;
                            ``(iii) to manage, link, and process 
                        different types of data, including information 
                        on newly reported cases, exposed contacts, 
                        laboratory results, number of people vaccinated 
                        or given prophylactic medications, adverse 
                        events monitoring and follow-up, in an 
                        integrated outbreak management system;
                            ``(iv) to geocode analyze, display, report, 
                        and map, using Geographic Information System 
                        technology, accumulated data and to share data 
                        with other local health departments, State 
                        health departments, and the Centers for Disease 
                        Control and Prevention;
                            ``(v) to receive, manage, and disseminate 
                        alerts, protocols, and other information, 
                        including Health Alert Network and Epi-X 
                        information, as appropriate, for public health 
                        workers, health care providers, and public 
                        health partners in emergency response within 
                        each health department's jurisdiction and to 
                        automate the exchange and cascading of such 
                        information with external partners using 
                        national standards;
                            ``(vi) to have information technology 
                        security and critical infrastructure protection 
                        as appropriate to protect public health 
                        information;
                            ``(vii) to have the technical 
                        infrastructure needed to ensure availability, 
                        backup, and disaster recovery of data, 
                        application services, and communications 
                        systems during natural disasters such as 
                        floods, tornados, hurricanes, and power 
                        outages; and
                            ``(viii) to provide for other capabilities 
                        as the Secretary determines appropriate.
                    ``(C) Laboratory systems.--An eligible entity shall 
                use amounts received under a grant under this section 
                to ensure that State or local public health 
                laboratories are utilizing web-based, secure systems 
                that are in compliance with the guidelines developed by 
                the Secretary under subparagraph (A) and that--
                            ``(i) are fully integrated laboratory 
                        information systems;
                            ``(ii) provide for the reporting of 
                        electronic test results to the appropriate 
                        local and State health departments using 
                        currently existing national format and coding 
                        standards;
                            ``(iii) have information technology 
                        security and critical infrastructure protection 
                        to protect public health information (as 
                        determined by the Secretary);
                            ``(iv) have the technical infrastructure 
                        needed to ensure availability, backup, and 
                        disaster recovery of data, application 
                        services, and communications systems during 
                        natural disasters including floods, tornadoes, 
                        hurricanes, and power outages; and
                            ``(v) address other capabilities as the 
                        Secretary determines appropriate.
                    ``(D) Other uses.--In addition to the activities 
                described in subparagraphs (B) and (C), an eligible 
                entity (including the entity's public health 
                laboratory) may use amounts received under a grant 
                under this section for systems development and 
                maintenance, hiring necessary staff, and staff 
                technical training. Grantees under this section may 
                elect to develop their own systems or use federally 
                developed systems in carrying out activities under this 
                paragraph.
    ``(d) Priority.--In allocating funds under subsection (f)(2) for 
activities under subsection (c)(2)(B) (relating to secure information 
systems), the Secretary shall give priority to eligible entities that 
demonstrate need.
    ``(e) Reports.--Not later than September 30, 2011, and each 
September 30 thereafter, the Secretary shall submit to Congress an 
annual report on the activities carried out under this section by 
recipients of assistance under this section.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $190,000,000 for each of fiscal 
years 2010 through 2013, of which--
            ``(1) not less than $95,000,000 shall be made available 
        each such fiscal year for activities under subsection (c)(1);
            ``(2) not less than $60,000,000 shall be made available 
        each such fiscal year for activities under subsection 
        (c)(2)(B); and
            ``(3) not less than $32,000,000 shall be made available 
        each such fiscal year for activities under subsection 
        (c)(2)(C).''.

SEC. 336. FEDERAL MESSAGING ON HEALTH PROMOTION AND DISEASE PREVENTION.

    (a) Media Campaign.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (referred to in this section as the ``Secretary''), 
        acting through the Director of the Centers for Disease Control 
        and Prevention, shall establish and implement a national 
        science-based media campaign on health promotion and disease 
        prevention.
            (2) Requirements of campaign.--The campaign implemented 
        under paragraph (1)--
                    (A) shall be designed to address proper nutrition, 
                regular exercise, smoking cessation, obesity reduction, 
                the 5 leading disease killers in the United States, and 
                secondary prevention through disease screening 
                promotion;
                    (B) shall be carried out through competitively bid 
                contracts awarded to entities providing for the 
                professional production and design of such campaign;
                    (C) may include the use of television, radio, 
                Internet, and other commercial marketing venues and may 
                be targeted to specific age groups based on peer-
                reviewed social research;
                    (D) shall not be duplicative of any other Federal 
                efforts relating to health promotion and disease 
                prevention; and
                    (E) may include the use of humor and nationally 
                recognized positive role models.
            (3) Evaluation.--The Secretary shall ensure that the 
        campaign implemented under paragraph (1) is subject to an 
        independent evaluation every 2 years and shall report every 2 
        years to Congress on the effectiveness of such campaigns 
        towards meeting science-based metrics.
    (b) Website.--The Secretary, in consultation with private-sector 
experts, shall maintain or enter into a contract to maintain an 
Internet website to provide science-based information on guidelines for 
nutrition, regular exercise, obesity reduction, smoking cessation, and 
specific chronic disease prevention. Such website shall be designed to 
provide information to health care providers and consumers.
    (c) Dissemination of Information Through Providers.--The Secretary, 
acting through the Centers for Disease Control and Prevention, shall 
develop and implement a plan for the dissemination of health promotion 
and disease prevention information consistent with national priorities, 
to health care providers who participate in Federal programs, including 
programs administered by the Indian Health Service, the Department of 
Veterans Affairs, the Department of Defense, and the Health Resources 
and Services Administration, and the Medicare and Medicaid Programs.
    (d) Personalized Prevention Plans.--
            (1) Contract.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention, shall enter 
        into a contract with a qualified entity for the development and 
        operation of a Federal Internet website personalized prevention 
        plan tool.
            (2) Use.--The website developed under paragraph (1) shall 
        be designed to be used as a source of the most up-to-date 
        scientific evidence relating to disease prevention for use by 
        individuals. Such website shall contain a component that 
        enables an individual to determine their disease risk (based on 
        personal health and family history, BMI, and other relevant 
        information) relating to the 5 leading diseases in the United 
        States, and obtain personalized suggestions for preventing such 
        diseases.
    (e) Internet Portal.--The Secretary shall establish an Internet 
portal for accessing risk-assessment tools developed and maintained by 
private and academic entities.
    (f) Priority Funding.--Funding for the activities authorized under 
this section shall take priority over funding provided through the 
Centers for Disease Control and Prevention for grants to States and 
other entities for similar purposes and goals as provided for in this 
section. Not to exceed $500,000,000 shall be expended on the campaigns 
and activities required under this section.

 Subtitle E--Advancing Research and Treatment for Pain Care Management

SEC. 341. INSTITUTE OF MEDICINE CONFERENCE ON PAIN.

    (a) Convening.--Not later than June 30, 2010, the Secretary of 
Health and Human Services shall seek to enter into an agreement with 
the Institute of Medicine of the National Academies to convene a 
Conference on Pain (in this section referred to as ``the Conference'').
    (b) Purposes.--The purposes of the Conference shall be to--
            (1) increase the recognition of pain as a significant 
        public health problem in the United States;
            (2) evaluate the adequacy of assessment, diagnosis, 
        treatment, and management of acute and chronic pain in the 
        general population, and in identified racial, ethnic, gender, 
        age, and other demographic groups that may be 
        disproportionately affected by inadequacies in the assessment, 
        diagnosis, treatment, and management of pain;
            (3) identify barriers to appropriate pain care, including--
                    (A) lack of understanding and education among 
                employers, patients, health care providers, regulators, 
                and third-party payors;
                    (B) barriers to access to care at the primary, 
                specialty, and tertiary care levels, including 
                barriers--
                            (i) specific to those populations that are 
                        disproportionately undertreated for pain;
                            (ii) related to physician concerns over 
                        regulatory and law enforcement policies 
                        applicable to some pain therapies; and
                            (iii) attributable to benefit, coverage, 
                        and payment policies in both the public and 
                        private sectors; and
                    (C) gaps in basic and clinical research on the 
                symptoms and causes of pain, and potential assessment 
                methods and new treatments to improve pain care; and
            (4) establish an agenda for action in both the public and 
        private sectors that will reduce such barriers and 
        significantly improve the state of pain care research, 
        education, and clinical care in the United States.
    (c) Other Appropriate Entity.--If the Institute of Medicine 
declines to enter into an agreement under subsection (a), the Secretary 
of Health and Human Services may enter into such agreement with another 
appropriate entity.
    (d) Report.--A report summarizing the Conference's findings and 
recommendations shall be submitted to the Congress not later than June 
30, 2011.
    (e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated $500,000 for 
each of fiscal years 2010 and 2011.

SEC. 342. PAIN RESEARCH AT NATIONAL INSTITUTES OF HEALTH.

    Part B of title IV of the Public Health Service Act (42 U.S.C. 284 
et seq.) is amended by adding at the end the following:

``SEC. 409J. PAIN RESEARCH.

    ``(a) Research Initiatives.--
            ``(1) In general.--The Director of NIH is encouraged to 
        continue and expand, through the Pain Consortium, an aggressive 
        program of basic and clinical research on the causes of and 
        potential treatments for pain.
            ``(2) Annual recommendations.--Not less than annually, the 
        Pain Consortium, in consultation with the Division of Program 
        Coordination, Planning, and Strategic Initiatives, shall 
        develop and submit to the Director of NIH recommendations on 
        appropriate pain research initiatives that could be undertaken 
        with funds reserved under section 402A(c)(1) for the Common 
        Fund or otherwise available for such initiatives.
            ``(3) Definition.--In this subsection, the term `Pain 
        Consortium' means the Pain Consortium of the National 
        Institutes of Health or a similar trans-National Institutes of 
        Health coordinating entity designated by the Secretary for 
        purposes of this subsection.
    ``(b) Interagency Pain Research Coordinating Committee.--
            ``(1) Establishment.--The Secretary shall establish not 
        later than 1 year after the date of the enactment of this 
        section and as necessary maintain a committee, to be known as 
        the Interagency Pain Research Coordinating Committee (in this 
        section referred to as the `Committee'), to coordinate all 
        efforts within the Department of Health and Human Services and 
        other Federal agencies that relate to pain research.
            ``(2) Membership.--
                    ``(A) In general.--The Committee shall be composed 
                of the following voting members:
                            ``(i) Not more than 7 voting Federal 
                        representatives as follows:
                                    ``(I) The Director of the Centers 
                                for Disease Control and Prevention.
                                    ``(II) The Director of the National 
                                Institutes of Health and the directors 
                                of such national research institutes 
                                and national centers as the Secretary 
                                determines appropriate.
                                    ``(III) The heads of such other 
                                agencies of the Department of Health 
                                and Human Services as the Secretary 
                                determines appropriate.
                                    ``(IV) Representatives of other 
                                Federal agencies that conduct or 
                                support pain care research and 
                                treatment, including the Department of 
                                Defense and the Department of Veterans 
                                Affairs.
                            ``(ii) 12 additional voting members 
                        appointed under subparagraph (B).
                    ``(B) Additional members.--The Committee shall 
                include additional voting members appointed by the 
                Secretary as follows:
                            ``(i) 6 members shall be appointed from 
                        among scientists, physicians, and other health 
                        professionals, who--
                                    ``(I) are not officers or employees 
                                of the United States;
                                    ``(II) represent multiple 
                                disciplines, including clinical, basic, 
                                and public health sciences;
                                    ``(III) represent different 
                                geographical regions of the United 
                                States; and
                                    ``(IV) are from practice settings, 
                                academia, manufacturers or other 
                                research settings; and
                            ``(ii) 6 members shall be appointed from 
                        members of the general public, who are 
                        representatives of leading research, advocacy, 
                        and service organizations for individuals with 
                        pain-related conditions.
                    ``(C) Nonvoting members.--The Committee shall 
                include such nonvoting members as the Secretary 
                determines to be appropriate.
            ``(3) Chairperson.--The voting members of the Committee 
        shall select a chairperson from among such members. The 
        selection of a chairperson shall be subject to the approval of 
        the Director of NIH.
            ``(4) Meetings.--The Committee shall meet at the call of 
        the chairperson of the Committee or upon the request of the 
        Director of NIH, but in no case less often than once each year.
            ``(5) Duties.--The Committee shall--
                    ``(A) develop a summary of advances in pain care 
                research supported or conducted by the Federal agencies 
                relevant to the diagnosis, prevention, and treatment of 
                pain and diseases and disorders associated with pain;
                    ``(B) identify critical gaps in basic and clinical 
                research on the symptoms and causes of pain;
                    ``(C) make recommendations to ensure that the 
                activities of the National Institutes of Health and 
                other Federal agencies, including the Department of 
                Defense and the Department of Veteran Affairs, are free 
                of unnecessary duplication of effort;
                    ``(D) make recommendations on how best to 
                disseminate information on pain care; and
                    ``(E) make recommendations on how to expand 
                partnerships between public entities, including Federal 
                agencies, and private entities to expand collaborative, 
                cross-cutting research.
            ``(6) Review.--The Secretary shall review the necessity of 
        the Committee at least once every 2 years.''.

SEC. 343. PAIN CARE EDUCATION AND TRAINING.

    Part D of title VII of the Public Health Service Act (42 U.S.C. 294 
et seq.) is amended by adding at the end the following new section:

``SEC. 759. PROGRAM FOR EDUCATION AND TRAINING IN PAIN CARE.

    ``(a) In General.--The Secretary may make awards of grants, 
cooperative agreements, and contracts to health professions schools, 
hospices, and other public and private entities for the development and 
implementation of programs to provide education and training to health 
care professionals in pain care.
    ``(b) Priorities.--In making awards under subsection (a), the 
Secretary shall give priority to awards for the implementation of 
programs under such subsection.
    ``(c) Certain Topics.--An award may be made under subsection (a) 
only if the applicant for the award agrees that the program carried out 
with the award will include information and education on--
            ``(1) recognized means for assessing, diagnosing, treating, 
        and managing pain and related signs and symptoms, including the 
        medically appropriate use of controlled substances;
            ``(2) applicable laws, regulations, rules, and policies on 
        controlled substances, including the degree to which 
        misconceptions and concerns regarding such laws, regulations, 
        rules, and policies, or the enforcement thereof, may create 
        barriers to patient access to appropriate and effective pain 
        care;
            ``(3) interdisciplinary approaches to the delivery of pain 
        care, including delivery through specialized centers providing 
        comprehensive pain care treatment expertise;
            ``(4) cultural, linguistic, literacy, geographic, and other 
        barriers to care in underserved populations; and
            ``(5) recent findings, developments, and improvements in 
        the provision of pain care.
    ``(d) Program Sites.--Education and training under subsection (a) 
may be provided at or through health professions schools, residency 
training programs, and other graduate programs in the health 
professions; entities that provide continuing education in medicine, 
pain management, dentistry, psychology, social work, nursing, and 
pharmacy; hospices; and such other programs or sites as the Secretary 
determines to be appropriate.
    ``(e) Evaluation of Programs.--The Secretary shall (directly or 
through grants or contracts) provide for the evaluation of programs 
implemented under subsection (a) in order to determine the effect of 
such programs on knowledge and practice of pain care.
    ``(f) Peer Review Groups.--In carrying out section 799(f) with 
respect to this section, the Secretary shall ensure that the membership 
of each peer review group involved includes individuals with expertise 
and experience in pain care.
    ``(g) Pain Care Defined.--For purposes of this section the term 
`pain care' means the assessment, diagnosis, treatment, or management 
of acute or chronic pain regardless of causation or body location.
    ``(h) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for each of the 
fiscal years 2010 through 2012. Amounts appropriated under this 
subsection shall remain available until expended.''.

SEC. 344. PUBLIC AWARENESS CAMPAIGN ON PAIN MANAGEMENT.

    Part B of title II of the Public Health Service Act (42 U.S.C. 238 
et seq.) is amended by adding at the end the following:

``SEC. 249. NATIONAL EDUCATION OUTREACH AND AWARENESS CAMPAIGN ON PAIN 
              MANAGEMENT.

    ``(a) Establishment.--Not later than June 30, 2010, the Secretary 
shall establish and implement a national pain care education outreach 
and awareness campaign described in subsection (b).
    ``(b) Requirements.--The Secretary shall design the public 
awareness campaign under this section to educate consumers, patients, 
their families, and other caregivers with respect to--
            ``(1) the incidence and importance of pain as a national 
        public health problem;
            ``(2) the adverse physical, psychological, emotional, 
        societal, and financial consequences that can result if pain is 
        not appropriately assessed, diagnosed, treated, or managed;
            ``(3) the availability, benefits, and risks of all pain 
        treatment and management options;
            ``(4) having pain promptly assessed, appropriately 
        diagnosed, treated, and managed, and regularly reassessed with 
        treatment adjusted as needed;
            ``(5) the role of credentialed pain management specialists 
        and subspecialists, and of comprehensive interdisciplinary 
        centers of treatment expertise;
            ``(6) the availability in the public, nonprofit, and 
        private sectors of pain management-related information, 
        services, and resources for consumers, employers, third-party 
        payors, patients, their families, and caregivers, including 
        information on--
                    ``(A) appropriate assessment, diagnosis, treatment, 
                and management options for all types of pain and pain-
                related symptoms; and
                    ``(B) conditions for which no treatment options are 
                yet recognized; and
            ``(7) other issues the Secretary deems appropriate.
    ``(c) Consultation.--In designing and implementing the public 
awareness campaign required by this section, the Secretary shall 
consult with organizations representing patients in pain and other 
consumers, employers, physicians including physicians specializing in 
pain care, other pain management professionals, medical device 
manufacturers, and pharmaceutical companies.
    ``(d) Coordination.--
            ``(1) Lead official.--The Secretary shall designate one 
        official in the Department of Health and Human Services to 
        oversee the campaign established under this section.
            ``(2) Agency coordination.--The Secretary shall ensure the 
        involvement in the public awareness campaign under this section 
        of the Surgeon General of the Public Health Service, the 
        Director of the Centers for Disease Control and Prevention, and 
        such other representatives of offices and agencies of the 
        Department of Health and Human Services as the Secretary 
        determines appropriate.
    ``(e) Underserved Areas and Populations.--In designing the public 
awareness campaign under this section, the Secretary shall--
            ``(1) take into account the special needs of geographic 
        areas and racial, ethnic, gender, age, and other demographic 
        groups that are currently underserved; and
            ``(2) provide resources that will reduce disparities in 
        access to appropriate diagnosis, assessment, and treatment.
    ``(f) Grants and Contracts.--The Secretary may make awards of 
grants, cooperative agreements, and contracts to public agencies and 
private nonprofit organizations to assist with the development and 
implementation of the public awareness campaign under this section.
    ``(g) Evaluation and Report.--Not later than the end of fiscal year 
2012, the Secretary shall prepare and submit to the Congress a report 
evaluating the effectiveness of the public awareness campaign under 
this section in educating the general public with respect to the 
matters described in subsection (b).
    ``(h) Authorization of Appropriations.--For purposes of carrying 
out this section, there are authorized to be appropriated $2,000,000 
for fiscal year 2010 and $4,000,000 for each of fiscal years 2011 
through 2012.''.

      Subtitle F--Coordinated Environmental Public Health Network

SEC. 351. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    The Public Health Service Act (42 U.S.C. 201 et seq.), as amended 
by section 332, is further amended by adding at the end the following:

     ``TITLE XXXIV--COORDINATED ENVIRONMENTAL PUBLIC HEALTH NETWORK

``SEC. 3400. DEFINITIONS.

    ``In this title:
            ``(1) Administrator.--The term `Administrator' means the 
        Administrator of the Environmental Protection Agency.
            ``(2) Coordinated network.--The term `Coordinated Network' 
        means the Coordinated Environmental Public Health Network 
        established under section 3401(a).
            ``(3) Director.--The term `Director' means the Director of 
        the Centers for Disease Control and Prevention.
            ``(4) Director of center.--The term `Director of Center' 
        means the Director of the National Center for Environmental 
        Health at the Centers for Disease Control and Prevention.
            ``(5) Medical privacy regulations.--The term `medical 
        privacy regulations' means the regulations promulgated under 
        section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996.
            ``(6) Priority chronic conditions and health effects.--The 
        term `priority chronic conditions and health effects' means the 
        conditions, as specified by the Secretary, to be tracked in the 
        Coordinated Network and the State Networks.
            ``(7) State network.--The term `State Network' means a 
        State Environmental Public Health Network established under 
        section 3401(b).
            ``(8) State.--The term `State' means a State, local 
        government, territory, or Indian tribe that is eligible to 
        receive a health tracking grant under section 3401(b).

``SEC. 3401. ESTABLISHMENT OF COORDINATED AND STATE ENVIRONMENTAL 
              PUBLIC HEALTH NETWORKS.

    ``(a) Coordinated Environmental Public Health Network.--Not later 
than 36 months after the date of the enactment of this title, the 
Secretary, acting through the Director, in consultation with the 
Administrator and the Director of Center, and with the involvement of 
other Federal agencies, and State and local health departments, shall 
establish and operate a Coordinated Environmental Public Health 
Network. In establishing and operating the Coordinated Network, the 
Secretary shall, as practicable--
            ``(1) identify, build upon, expand, and coordinate among 
        existing data and surveillance systems, surveys, registries, 
        and other Federal public health and environmental 
        infrastructure as practicable;
            ``(2) provide for public access to an electronic national 
        database that accepts data from the State Networks on the 
        incidence and prevalence of priority chronic conditions and 
        health effects and relevant environmental and other factors, in 
        a manner which protects personal privacy consistent with the 
        medical privacy regulations;
            ``(3) prepare, publish, and submit to Congress--
                    ``(A) not later than 12 months after the date of 
                enactment of this title, and annually thereafter, a 
                Coordinated Network Status Report, including a 
                statement of the activities carried out under this 
                title, the identification of gaps in the data of the 
                coordinated Network, including diseases of concern and 
                environmental exposures not tracked, and identification 
                of key milestones achieved in the preceding year, with 
                such report to be made available to the public on the 
                websites of the Centers for Disease Control and 
                Prevention and the Environmental Protection Agency; and
                    ``(B) not later than 2 years after the date of 
                enactment of this title, and biennially thereafter, a 
                Coordinated Network Health and Environment Report, 
                including a statement of the activities carried out 
                under this title, an analysis of the most currently 
                available incidence, prevalence, and trends of priority 
                chronic conditions and health effects, and potentially 
                relevant environmental and other factors, by State and, 
                as practicable by local areas, and recommendations 
                regarding high risk populations, public health 
                concerns, response and prevention strategies, and 
                additional tracking needs, in order to allow the public 
                to access and understand information about 
                environmental health at the Federal, State, and, where 
                practicable, local level;
            ``(4) provide for the establishment of State Networks, and 
        coordinate the State Networks as provided for under subsection 
        (b);
            ``(5) provide technical assistance to support the State 
        Networks;
            ``(6) not later than 12 months after the date of the 
        enactment of this title, develop minimum standards and 
        procedures for data collection and reporting for the State 
        Networks, to be updated not less than annually thereafter; and
            ``(7) in developing the minimum standards and procedures 
        under subparagraph (F), include mechanisms for allowing the 
        States to set priorities, and allocate resources accordingly.
    ``(b) State Environmental Public Health Networks.--
            ``(1) Grants.--Not later than 12 months after the date of 
        the enactment of this title, the Secretary, acting through the 
        Director, in consultation with the Administrator and the 
        Director of Center shall award grants to States for the 
        establishment, maintenance, and operation of State Networks in 
        accordance with the minimum standards and procedures 
        established by the Secretary under subsection (a)(3).
            ``(2) Specialized assistance.--The Coordinated Network 
        shall provide specialized assistance to grantees in the 
        establishment, maintenance, and operation of State Networks.
            ``(3) Requirements.--A State receiving a grant under this 
        subsection shall use the grant--
                    ``(A) to establish an environmental public health 
                network that will provide--
                            ``(i) for the tracking of the incidence, 
                        prevalence, and trends of priority chronic 
                        conditions and health effects, as well as any 
                        additional priority chronic conditions and 
                        health effects and potentially related 
                        environmental exposures of concern to that 
                        State;
                            ``(ii) for identification of priority 
                        chronic conditions and health effects and 
                        potentially relevant environmental and other 
                        factors that disproportionately impact low 
                        income and minority communities;
                            ``(iii) for the protection of the 
                        confidentiality of all personal data reported, 
                        in accordance with the medical privacy 
                        regulations;
                            ``(iv) a means by which confidential data 
                        may, in accordance with Federal and State law, 
                        be disclosed to researchers for the purposes of 
                        public health research;
                            ``(v) the fullest possible public access to 
                        data collected by the State Network or through 
                        the Coordinated Network, while ensuring that 
                        individual privacy is protected in accordance 
                        with subsection (a)(1)(B); and
                            ``(vi) for the collection of exposure data 
                        through biomonitoring and other methods, which 
                        may include the entering into of cooperative 
                        agreements as described in section 3404;
                    ``(B) to develop a publicly available plan for 
                establishing the State Network in order to meet minimum 
                standards and procedures as developed by the Secretary 
                under subsection (a)(1)(F);
                    ``(C) to appoint a lead public health department or 
                agency that will be responsible for the development, 
                operation, and maintenance of the State Network, and 
                ensure the appropriate coordination among State and 
                local agencies, including environmental agencies, 
                regarding the development, operation, and maintenance 
                of the State Network; and
                    ``(D) to recruit and train public health officials 
                to continue to expand the State Network.
            ``(4) Limitation.--A State that receives a grant under this 
        section may not use more than 10 percent of the funds made 
        available through the grant for administrative costs.
            ``(5) Application.--To seek a grant under this section, a 
        State shall submit to the Secretary an application at such 
        time, in such form and manner, and accompanied by such 
        information as the Secretary may specify.
    ``(c) Pilot Projects.--
            ``(1) In general.--A State may apply for a grant under this 
        subsection to implement a pilot project that is approved by the 
        Secretary, acting through the Director and in consultation with 
        the Administrator, and the Director of Center.
            ``(2) Activities.--A State shall use amounts received under 
        a grant under this subsection to carry out a pilot project 
        designed to develop State Network enhancements and to develop 
        programs to address specific local and regional concerns.
            ``(3) Results.--The Secretary may consider the results of 
        the pilot projects under this subsection for inclusion into the 
        Coordinated Network.
    ``(d) Privacy.--In establishing and operating the Coordinated 
Network under subsection (a), and in making grants under subsections 
(b) and (c), the Secretary shall ensure the protection of privacy of 
individually identifiable health information, including ensuring 
protection consistent with the regulations promulgated under section 
264(c) of the Health Insurance Portability and Accountability Act of 
1996 (42 U.S.C. 1320d-2 note).
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2014.

``SEC. 3402. INCREASING PUBLIC HEALTH PERSONNEL CAPACITY.

    ``(a) In General.--Beginning in fiscal year 2010, the Secretary, 
acting through the Director, shall enter into a cooperative agreement 
with the Council of State and Territorial Epidemiologists to train and 
place, in State and local health departments, applied epidemiology 
fellows to enhance State and local public health capacity in the areas 
of environmental health, chronic and other noninfectious diseases and 
conditions, and public health surveillance.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2014.

``SEC. 3403. GENERAL PROVISION.

    ``The Secretary shall integrate the enactment of this title with 
all environmental health tracking programs funded prior to the date of 
enactment of this title, including by integrating the programs, in 
existence on the date of enactment of this title, to develop State 
Network enhancements and to develop programs to address specific local 
and regional concerns.

``SEC. 3404. EXPANSION OF BIOMONITORING CAPABILITIES AND DATA 
              COLLECTION.

    ``(a) Purpose.--It is the purpose of this section to expand the 
scope and amount of biomonitoring data collected and analyzed by the 
Centers for Disease Control and Prevention, State laboratories, and 
consortia of State laboratories, in order to obtain robust information, 
including information by geographically defined areas and 
subpopulations, about a range of environmental exposures.
    ``(b) In General.--In meeting the purpose of this section, the 
Secretary shall ensure that biomonitoring data are collected 
intramurally through appropriate sources, including the National Health 
and Nutrition Examination Survey, and extramurally shall enter into 
collaboration or partnerships with other entities to obtain additional 
information regarding vulnerable subpopulations or other 
subpopulations.
    ``(c) Cooperative Agreements.--
            ``(1) In general.--The Secretary, acting through the 
        Director, shall enter into cooperative agreements with States 
        or consortia of States to support the purposes of this title.
            ``(2) Applications.--Applications for such cooperative 
        agreements by consortia of States shall address the manner in 
        which such States will coordinate activities with other States 
        in the region, and shall designate a lead State for 
        administrative purposes.
            ``(3) Training and quality assurance.--The Secretary, 
        acting through the Director, shall through the cooperative 
        agreements with States or a consortia of States provide 
        laboratory training and quality assurance.
    ``(d) Privacy.--In carrying out this section, the Secretary shall 
ensure the protection of privacy of individually identifiable health 
information, including ensuring protection consistent with the 
regulations promulgated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note).
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2014.''.

                  Subtitle G--Miscellaneous Provisions

SEC. 361. SENSE OF THE SENATE CONCERNING CBO SCORING.

    (a) Finding.--The Senate finds that the costs of prevention 
programs are difficult to estimate due in part because prevention 
initiatives are hard to measure and results may occur outside the 5 and 
10 year budget windows.
    (b) Sense of Congress.--It is the sense of the Senate that Congress 
should work with the Congressional Budget Office to develop better 
methodologies for scoring progress to be made in prevention and 
wellness programs.

SEC. 362. EFFECTIVENESS OF FEDERAL HEALTH AND WELLNESS INITIATIVES.

    To determine whether existing Federal health and wellness 
initiatives are effective in achieving their stated goals, the 
Secretary of Health and Human Services shall--
            (1) conduct an evaluation of such programs as they relate 
        to changes in health status of the American public and 
        specifically on the health status of the Federal workforce, 
        including absenteeism of employees, the productivity of 
        employees, the rate of workplace injury, and the medical costs 
        incurred by employees, and health conditions, including 
        workplace fitness, healthy food and beverages, and incentives 
        in the Federal Employee Health Benefits Program; and
            (2) submit to Congress a report concerning such evaluation, 
        which shall include conclusions concerning the reasons that 
        such existing programs have proven successful or not successful 
        and what factors contributed to such conclusions.

                    TITLE IV--HEALTH CARE WORKFORCE

                  Subtitle A--Purpose and Definitions

SEC. 401. PURPOSE.

    The purpose of this title is to improve access to and the delivery 
of health care services for all individuals, particularly low income, 
underserved, uninsured, minority, health disparity, and rural 
populations by--
            (1) gathering and assessing comprehensive data in order for 
        the health care workforce to meet the health care needs of 
        individuals, including research on the supply, demand, 
        distribution, diversity, and skills needs of the health care 
        workforce;
            (2) increasing the supply of a qualified health care 
        workforce to improve access to and the delivery of health care 
        services for all individuals;
            (3) enhancing health care workforce education and training 
        to improve access to and the delivery of health care services 
        for all individuals; and
            (4) providing support to the existing health care workforce 
        to improve access to and the delivery of health care services 
        for all individuals.

SEC. 402. DEFINITIONS.

    (a) This Title.--In this title:
            (1) Health care career pathway.--The term ``healthcare 
        career pathway'' means a rigorous, engaging, and high quality 
        set of courses and services that--
                    (A) includes an articulated sequence of academic 
                and career courses, including 21st century skills;
                    (B) is aligned with the needs of healthcare 
                industries in a region or State;
                    (C) prepares students for entry into the full range 
                of postsecondary education options, including 
                registered apprenticeships, and careers;
                    (D) provides academic and career counseling in 
                student-to-counselor ratios that allow students to make 
                informed decisions about academic and career options;
                    (E) meets State academic standards, State 
                requirements for secondary school graduation and is 
                aligned with requirements for entry into postsecondary 
                education, and applicable industry standards; and
                    (F) leads to 2 or more credentials, including--
                            (i) a secondary school diploma; and
                            (ii) a postsecondary degree, an 
                        apprenticeship or other occupational 
                        certification, a certificate, or a license.
            (2) Institution of higher education.--The term 
        ``institution of higher education'' has the meaning given the 
        term in sections 101 and 102 of the Higher Education Act of 
        1965 (20 U.S.C. 1001 and 1002).
            (3) Low income individual, state workforce investment 
        board, and local workforce investment board.--The terms ``low-
        income individual'', ``State workforce investment board'', and 
        ``local workforce investment board'', have the meanings given 
        the terms in section 101 of the Workforce investment Act of 
        1998 (29 U.S.C. 2801).
            (4) Postsecondary education.--The term ``postsecondary 
        education'' means--
                    (A) a 4-year program of instruction, or not less 
                than a 1-year program of instruction that is acceptable 
                for credit toward an associate or a baccalaureate 
                degree, offered by an institution of higher education; 
                or
                    (B) a certificate or registered apprenticeship 
                program at the postsecondary level offered by an 
                institution of higher education or a non-profit 
                educational institution.
            (5) Registered apprenticeship program.--The term 
        ``registered apprenticeship program'' means an industry skills 
        training program at the postsecondary level that combines 
        technical and theoretical training through structure on the job 
        learning with related instruction (in a classroom or through 
        distance learning) while an individual is employed, working 
        under the direction of qualified personnel or a mentor, and 
        earning incremental wage increases aligned to enhance job 
        proficiency, resulting in the acquisition of a nationally 
        recognized and portable certificate, under a plan approved by 
        the Office of Apprenticeship or a State agency recognized by 
        the Department of Labor.
    (b) Title VII of the Public Health Service Act.--Section 799B of 
the Public Health Service Act (42 U.S.C. 295p) is amended--
            (1) by striking paragraph (3) and inserting the following:
            ``(3) Physician assistant education program.--The term 
        `physician assistant education program' means an educational 
        program in a public or private institution in a State that--
                    ``(A) has as its objective the education of 
                individuals who, upon completion of their studies in 
                the program, be qualified to provide primary care 
                medical services with the supervision of a physician; 
                and
                    ``(B) is accredited by the Accreditation Review 
                Commission on Education for the Physician Assistant.''; 
                and
            (2) by adding at the end the following:
            ``(12) Area health education center.--The term `area health 
        education center' means a public or nonprofit private 
        organization that has a cooperative agreement or contract in 
        effect with an entity that has received an award under 
        subsection (b) or (c) of section 751, satisfies the 
        requirements in section 751(d)(1), and has as one of its 
        principal functions the operation of an area health education 
        center. Appropriate organizations may include hospitals, health 
        organizations with accredited primary care training programs, 
        accredited physician assistant educational programs associated 
        with a college or university, and universities or colleges not 
        operating a school of medicine or osteopathic medicine.
            ``(13) Area health education center program.--The term 
        `area health education center program' means cooperative 
        program consisting of an entity that has received an award 
        under subsection (b) or (c) of section 751 for the purpose of 
        planning, developing, operating, and evaluating an area health 
        education center program and one or more area health education 
        centers, which carries out the required activities described in 
        subsection (b)(4) or (c)(4) of section 751, satisfies the 
        program requirements in such section, has as one of its 
        principal functions identifying and implementing strategies and 
        activities that address health care workforce needs in its 
        service area, in coordination with the local workforce 
        investment boards.
            ``(14) Clinical social worker.--The term `clinical social 
        worker' has the meaning given the term in section 1861(hh)(1) 
        of the Social Security Act (42 U.S.C. 1395x(hh)(1)).
            ``(15) Cultural competency.--The term `cultural competency' 
        shall be defined by the Secretary in a manner consistent with 
        section 1707(d)(3).
            ``(16) Direct care worker.--The term `direct care worker' 
        has the meaning given that term in the 2010 Standard 
        Occupational Classifications of the Department of Labor for 
        Home Health Aides [31-1011], Psychiatric Aides [31-1013], 
        Nursing Assistants [31-1014], and Personal Care Aides [39-
        9021].
            ``(17) Federally qualified health center.--The term 
        `Federally qualified health center' has the meaning given that 
        term in section 1861(aa) of the Social Security Act (42 U.S.C. 
        1395x(aa)).
            ``(18) Frontier health professional shortage area.--The 
        term `frontier health professional shortage area' means an 
        area--
                    ``(A) with a population density less than 6 persons 
                per square mile within the service area; and
                    ``(B) with respect to which the distance or time 
                for the population to access care is excessive.
            ``(19) Graduate psychology.--The term `graduate psychology' 
        means an accredited program in professional psychology.
            ``(20) Health disparity population.--The term `health 
        disparity population' has the meaning given such term in 
        section 903(d)(1).
            ``(21) Health literacy.--The term `health literacy' means 
        the degree to which an individual has the capacity to obtain, 
        communicate, process, and understand health information and 
        services in order to make appropriate health decisions.
            ``(22) Mental health service professional.--The term 
        `mental health service professional' means an individual with a 
        graduate or postgraduate degree from an accredited institution 
        of higher education in psychiatry, psychology, school 
        psychology, behavioral pediatrics, psychiatric nursing, social 
        work, school social work, substance abuse disorder prevention 
        and treatment, marriage and family counseling, school 
        counseling, or professional counseling.
            ``(23) One-stop delivery system center.--The term `one-stop 
        delivery system' means a one-stop delivery system described in 
        section 134(c) of the Workforce Investment Act of 1998 (29 
        U.S.C. 2864(c)).
            ``(24) Paraprofessional child and adolescent mental health 
        worker.--The term `paraprofessional child and adolescent mental 
        health worker' means an individual who is not a mental or 
        behavioral health service professional, but who works at the 
        first stage of contact with children and families who are 
        seeking mental or behavioral health services, including 
        substance abuse prevention and treatment services.
            ``(25) Racial and ethnic minority group; racial and ethnic 
        minority population.--The terms `racial and ethnic minority 
        group' and `racial and ethnic minority population' have the 
        meaning given the term `racial and ethnic minority group' in 
        section 1707.
            ``(26) Rural health clinic.--The term `rural health clinic' 
        has the meaning given that term in section 1861(aa) of the 
        Social Security Act (42 U.S.C. 1395x(aa)).''.
    (c) Title VIII of the Public Health Service Act.--Section 801 of 
the Public Health Service Act (42 U.S.C. 296) is amended--
            (1) in paragraph (2)--
                    (A) by striking ``means a'' and inserting ``means 
                an accredited (as defined in paragraph 6)''; and
                    (B) by striking the period as inserting the 
                following: ``where graduates are--
                    ``(A) authorized to sit for the National Council 
                Licensure EXamination-Registered Nurse (NCLEX-RN); or
                    ``(B) licensed registered nurses who will receive a 
                graduate or equivalent degree or training to become an 
                advanced education nurse as defined by section 
                811(b).''; and
            (2) by adding at the end the following:
            ``(16) Accelerated nursing degree program.--The term 
        `accelerated nursing degree program' means a program of 
        education in professional nursing offered by an accredited 
        school of nursing in which an individual holding a bachelors 
        degree in another discipline receives a BSN or MSN degree in an 
        accelerated time frame as determined by the accredited school 
        of nursing.
            ``(17) Bridge or degree completion program.--The term 
        `bridge or degree completion program' means a program of 
        education in professional nursing offered by an accredited 
        school of nursing, as defined in paragraph (2), that leads to a 
        baccalaureate degree in nursing. Such programs may include, 
        Registered Nurse (RN) to Bachelor's of Science of Nursing (BSN) 
        programs, RN to MSN (Master of Science of Nursing) programs, or 
        BSN to Doctoral programs.''.

          Subtitle B--Innovations in the Health Care Workforce

SEC. 411. NATIONAL HEALTH CARE WORKFORCE COMMISSION.

    (a) Purpose.--It is the purpose of this section to establish a 
National Health Care Workforce Commission that--
            (1) serves as a national resource for Congress, the 
        President, States, and localities by--
                    (A) disseminating information on current and 
                projected health care workforce supply and demand;
                    (B) disseminating information on health care 
                workforce education and training capacity and 
                instruction or delivery models and best practices;
                    (C) recognizing efforts of Federal, State, and 
                local partnerships to develop and offer health care 
                career pathways of proven effectiveness;
                    (D) disseminating information on promising 
                retention practices for health care professionals;
                    (E) communicating information on important policies 
                and practices that affect the recruitment, education 
                and training, and retention of the health care 
                workforce; and
                    (F) disseminating recommendations on the 
                development of a fiscally sustainable integrated 
                workforce that supports a high-quality health care 
                delivery system that meets the needs of patients and 
                populations;
            (2) communicates and coordinates with the Departments of 
        Health and Human Services, Labor, Veterans Affairs, Homeland 
        Security, and Education on related activities administered by 
        one or more of such Departments;
            (3) develops and commissions evaluations of education and 
        training activities to determine whether the demand for health 
        care workers is being met;
            (4) identifies barriers to improved coordination at the 
        Federal, State, and local levels and recommend ways to address 
        such barriers; and
            (5) encourages innovations to address population needs, 
        constant changes in technology, and other environmental 
        factors.
    (b) Establishment.--There is hereby established the National Health 
Care Workforce Commission (in this section referred to as the 
``Commission'').
    (c) Membership.--
            (1) Number and appointment.--The Commission shall be 
        composed of 15 members to be appointed by the Comptroller 
        General, without regard to section 5 of the Federal Advisory 
        Committee Act (5 U.S.C. App.).
            (2) Qualifications.--
                    (A) In general.--The membership of the Commission 
                shall include individuals--
                            (i) with national recognition for their 
                        expertise in health care labor market analysis, 
                        including health care workforce analysis; 
                        health care finance and economics; health care 
                        facility management; health care plans and 
                        integrated delivery systems; health care 
                        workforce education and training; health care 
                        philanthropy; providers of health care 
                        services; and other related fields; and
                            (ii) who will provide a combination of 
                        professional perspectives, broad geographic 
                        representation, and a balance between urban, 
                        suburban, rural, and frontier representatives.
                    (B) Inclusion.--
                            (i) In general.--The membership of the 
                        Commission shall include no less than one 
                        representative of--
                                    (I) the health care workforce and 
                                health professionals;
                                    (II) employers;
                                    (III) third-party payers;
                                    (IV) individuals skilled in the 
                                conduct and interpretation of health 
                                care services and health economics 
                                research;
                                    (V) representatives of consumers;
                                    (VI) labor unions;
                                    (VII) State or local workforce 
                                investment boards; and
                                    (VIII) educational institutions 
                                (which may include elementary and 
                                secondary institutions, institutions of 
                                higher education, including 2 and 4 
                                year institutions, or registered 
                                apprenticeship programs).
                            (ii) Additional members.--The remaining 
                        membership may include additional 
                        representatives from clause (i) and other 
                        individuals as determined appropriate by the 
                        Comptroller General of the United States.
                    (C) Majority non-providers.--Individuals who are 
                directly involved in health professions education or 
                practice shall not constitute a majority of the 
                membership of the Commission.
                    (D) Ethical disclosure.--The Comptroller General 
                shall establish a system for public disclosure by 
                members of the Commission of financial and other 
                potential conflicts of interest relating to such 
                members. Members of the Commission shall be treated as 
                employees of Congress for purposes of applying title I 
                of the Ethics in Government Act of 1978. Members of the 
                Commission shall not be treated as special government 
                employees under title 18, United States Code.
            (3) Terms.--
                    (A) In general.--The terms of members of the 
                Commission shall be for 3 years except that the 
                Comptroller General shall designate staggered terms for 
                the members first appointed.
                    (B) Vacancies.--Any member appointed to fill a 
                vacancy occurring before the expiration of the term for 
                which the member's predecessor was appointed shall be 
                appointed only for the remainder of that term. A member 
                may serve after the expiration of that members term 
                until a successor has taken office. A vacancy in the 
                Commission shall be filled in the manner in which the 
                original appointment was made.
                    (C) Initial appointments.--The Comptroller General 
                shall make initial appointments of members to the 
                Commission not later than September 30, 2010.
            (4) Compensation.--While serving on the business of the 
        Commission (including travel time), a member of the Commission 
        shall be entitled to compensation at the per diem equivalent of 
        the rate provided for level IV of the Executive Schedule under 
        section 5315 of tile 5, United States Code, and while so 
        serving away from home and the member's regular place of 
        business, a member may be allowed travel expenses, as 
        authorized by the Chairman of the Commission. Physicians 
        serving as personnel of the Commission may be provided a 
        physician comparability allowance by the Commission in the same 
        manner as Government physicians may be provided such an 
        allowance by an agency under section 5948 of title 5, United 
        States Code, and for such purpose subsection (i) of such 
        section shall apply to the Commission in the same manner as it 
        applies to the Tennessee Valley Authority. For purposes of pay 
        (other than pay of members of the Commission) and employment 
        benefits, rights, and privileges, all personnel of the 
        Commission shall be treated as if they were employees of the 
        United States Senate. Personnel of the Commission shall not be 
        treated as employees of the Government Accountability Office 
        for any purpose.
            (5) Chairman, vice chairman.--The Comptroller General shall 
        designate a member of the Commission, at the time of 
        appointment of the member, as Chairman and a member as Vice 
        Chairman for that term of appointment, except that in the case 
        of vacancy of the chairmanship or vice chairmanship, the 
        Comptroller General may designate another member for the 
        remainder of that member's term.
            (6) Meetings.--The Commission shall meet at the call of the 
        chairman, but no less frequently than on a quarterly basis.
    (d) Duties.--
            (1) Review of health care workforce and annual reports.--In 
        order to develop a fiscally sustainable integrated workforce 
        that supports a high-quality, readily accessible health care 
        delivery system that meets the needs of patients and 
        populations, the Commission, in consultation with relevant 
        Federal, State, and local agencies, shall--
                    (A) review current and projected health care 
                workforce supply and demand, including the topics 
                described in paragraph (2);
                    (B) make recommendations to Congress and the 
                Administration concerning national health care 
                workforce priorities, goals, and policies;
                    (C) by not later than October 1 of each year 
                (beginning with 2011), submit a report to Congress and 
                the Administration containing the results of such 
                reviews and recommendations concerning related 
                policies; and
                    (D) by not later than April 1 of each year 
                (beginning with 2011), submit a report to Congress and 
                the Administration containing a review of, and 
                recommendations on, at a minimum one high priority area 
                as described in paragraph (3).
            (2) Specific topics to be reviewed.--The topics described 
        in this paragraph include--
                    (A) current health care workforce supply and 
                distribution, including demographics, skill sets, and 
                demands, with projected demands during the subsequent 
                10 and 25 year periods;
                    (B) health care workforce education and training 
                capacity, including the number of students who have 
                completed education and training, including registered 
                apprenticeships; the number of qualified faculty; the 
                education and training infrastructure; and the 
                education and training demands, with projected demands 
                during the subsequent 10 and 25 year periods, and 
                including identified models of education and training 
                delivery and best practices;
                    (C) the education loan and grant programs in titles 
                VII and VIII of the Public Health Service Act (42 
                U.S.C. 292 et seq. and 296 et seq.), with 
                recommendations on whether such programs should become 
                part of the Higher Education Act of 1965 (20 U.S.C. 
                1001 et seq);
                    (D) the implications of new and existing Federal 
                policies which affect the health care workforce, 
                including Medicare and Medicaid graduate medical 
                education policies, titles VII and VIII of the Public 
                Health Service Act (42 U.S.C. 292 et seq. and 296 et 
                seq.), the National Health Service Corps (with 
                recommendations for aligning such programs with 
                national health workforce priorities and goals), and 
                other health care workforce programs, including those 
                supported through the Workforce Investment Act of 1998 
                (29 U.S.C. 2801 et seq.), the Carl D. Perkins Career 
                and Technical Education Act of 2006 (20 U.S.C. 2301 et 
                seq.), the Higher Education Act of 1965 (20 U.S.C. 1001 
                et seq.), and any other Federal health care workforce 
                programs;
                    (E) the health care workforce needs of special 
                populations, such as minorities, rural populations, 
                medically underserved populations, gender specific 
                needs, individuals with disabilities, and geriatric and 
                pediatric populations with recommendations for new and 
                existing Federal policies to meet the needs of these 
                special populations; and
                    (F) recommendations creating or revising national 
                loan repayment programs and scholarship programs to 
                require low-income, minority medical students to serve 
                in their home communities, if designated as medical 
                underserved community.
            (3) High priority areas.--
                    (A) In general.--The initial high priority topics 
                described in this paragraph include--
                            (i) integrated health care workforce 
                        planning that identifies health care 
                        professional skills needed and maximizes the 
                        skill sets of health care professionals across 
                        disciplines;
                            (ii) an analysis of the nature, scopes of 
                        practice, and demands for health care workers 
                        in the enhanced information technology and 
                        management workplace;
                            (iii) Medicare and Medicaid graduate 
                        medical education policies and recommendations, 
                        including increasing direct payments to 
                        community based training sites and medical 
                        training programs, for aligning with national 
                        workforce goals;
                            (iv) nursing workforce capacity at all 
                        levels, including education and training 
                        capacity, projected demands, and integration 
                        within the health care delivery system;
                            (v) oral health care workforce capacity, 
                        including education and training capacity, 
                        projected demands, and integration within the 
                        health care delivery system;
                            (vi) mental and behavioral health care 
                        workforce capacity, including education and 
                        training capacity, projected demands, and 
                        integration within the health care delivery 
                        system;
                            (vii) allied health and public health care 
                        workforce capacity, including education and 
                        training capacity, projected demands, and 
                        integration within the health care delivery 
                        system;
                            (viii) the geographic distribution of 
                        health care providers as compared to the 
                        identified health care workforce needs of 
                        States and regions; and
                            (ix) emergency medical service workforce 
                        capacity, including training and the retention 
                        and recruitment of the volunteer workforce.
                    (B) Future determinations.--The Commission may 
                require that additional topics be included under 
                subparagraph (A). The appropriate committees of 
                Congress may recommend to the Commission the inclusion 
                of other topics for health care workforce development 
                areas that require special attention.
            (4) Grant program.--The Commission shall review 
        implementation progress reports on, and report to Congress 
        about, the State Health Care Workforce Development Grants 
        program established in section 412.
            (5) Study.--The Commission shall study effective mechanisms 
        for financing education and training for careers in health 
        care, including public health and allied health.
            (6) Recommendations.--The Commission shall submit 
        recommendations to Congress, the Department of Labor, and the 
        Department of Health and Human Services about improving safety, 
        health, and worker protections in the workplace for the health 
        care workforce.
            (7) Assessment.--The Commission shall assess and receive 
        reports from the National Center for Health Care Workforce 
        Analysis established under title VII of the Public Service 
        Health Act.
    (e) Consultation With Federal, State, and Local Agencies, Congress, 
and Other Organizations.--
            (1) In general.--The Commission shall consult with Federal 
        agencies (including the Departments of Health and Human 
        Services, Labor, Education, Commerce, Agriculture, Defense, and 
        Veterans Affairs and the Environmental Protection Agency), 
        Congress, the Medicare Payment Advisory Commission, the 
        Medicaid and CHIP Payment and Access Commission, and, to the 
        extent practicable, with State and local agencies, Indian 
        tribes, voluntary health care organizations, professional 
        societies, and other relevant public-private health care 
        partnerships.
            (2) Obtaining official data.--The Commission, consistent 
        with established privacy rules, may secure directly from any 
        department or agency of the Executive Branch information 
        necessary to enable the Commission to carry out this section.
            (3) Detail of federal government employees.--An employee of 
        the Federal Government may be detailed to the Commission 
        without reimbursement. The detail of such an employee shall be 
        without interruption or loss of civil service status.
    (f) Director and Staff; Experts and Consultants.--Subject to such 
review as the Comptroller General of the United States determines to be 
necessary to ensure the efficient administration of the Commission, the 
Commission may--
            (1) employ and fix the compensation of an executive 
        director that shall not exceed the rate of basic pay payable 
        for level V of the Executive Schedule and such other personnel 
        as may be necessary to carry out its duties (without regard to 
        the provisions of title 5, United States Code, governing 
        appointments in the competitive service);
            (2) seek such assistance and support as may be required in 
        the performance of its duties from appropriate Federal 
        departments and agencies;
            (3) enter into contracts or make other arrangements, as may 
        be necessary for the conduct of the work of the Commission 
        (without regard to section 3709 of the Revised Statutes (41 
        U.S.C. 5));
            (4) make advance, progress, and other payments which relate 
        to the work of the Commission;
            (5) provide transportation and subsistence for persons 
        serving without compensation; and
            (6) prescribe such rules and regulations as the Commission 
        determines to be necessary with respect to the internal 
        organization and operation of the Commission.
    (g) Powers.--
            (1) Data collection.--In order to carry out its functions 
        under this section, the Commission shall--
                    (A) utilize existing information, both published 
                and unpublished, where possible, collected and assessed 
                either by its own staff or under other arrangements 
                made in accordance with this section, including 
                coordination with the Bureau of Labor Statistics;
                    (B) carry out, or award grants or contracts for the 
                carrying out of, original research and development, 
                where existing information is inadequate, and
                    (C) adopt procedures allowing interested parties to 
                submit information for the Commission's use in making 
                reports and recommendations.
            (2) Access of the government accountability office to 
        information.--The Comptroller General of the United States 
        shall have unrestricted access to all deliberations, records, 
        and data of the Commission, immediately upon request.
            (3) Periodic audit.--The Commission shall be subject to 
        periodic audit by an independent public accountant under 
        contract to the Commission.
    (h) Authorization of Appropriations.--
            (1) Request for appropriations.--The Commission shall 
        submit requests for appropriations in the same manner as the 
        Comptroller General of the United States submits requests for 
        appropriations. Amounts so appropriated for the Commission 
        shall be separate from amounts appropriated for the Comptroller 
        General.
            (2) Authorization.--There are authorized to be appropriated 
        such sums as may be necessary to carry out this section.
            (3) Gifts.--The Commission is authorized to accept and 
        gifts for purposing of carrying out this section.
    (i) Definitions.--In this section:
            (1) Health care workforce.--The term ``health care 
        workforce'' includes all health care providers with direct 
        patient care and support responsibilities, such as physicians, 
        nurses, nurse practitioners, primary care providers, preventive 
        medicine physicians, optometrists, ophthalmologists, physician 
        assistants, pharmacists, dentists, dental hygienists, and other 
        oral healthcare professionals, allied health professionals, 
        doctors of chiropractic, community health workers, health care 
        paraprofessionals, direct care workers, psychologists and other 
        behavioral and mental health professionals (including substance 
        abuse prevention and treatment providers), social workers, 
        physical and occupational therapists, certified nurse midwives, 
        podiatrists, the EMS workforce (including professional and 
        volunteer ambulance personnel and firefighters who perform 
        emergency medical services), licensed complementary and 
        alternative medicine providers, integrative health 
        practitioners, public health professionals, and any other 
        health professional that the Comptroller General of the United 
        States determines appropriate.
            (2) Health professionals.--The term ``health 
        professionals'' includes--
                    (A) dentists, dental hygienists, primary care 
                providers, specialty physicians, nurses, nurse 
                practitioners, physician assistants, psychologists and 
                other behavioral and mental health professionals 
                (including substance abuse prevention and treatment 
                providers), social workers, physical therapists, public 
                health professionals, clinical pharmacists, allied 
                health professionals, doctors of chiropractic, 
                community health workers, school nurses, certified 
                nurse midwives, podiatrists, licensed complementary and 
                alternative medicine providers, the EMS workforce 
                (including professional and volunteer ambulance 
                personnel and firefighters who perform emergency 
                medical services), and integrative health 
                practitioners;
                    (B) national representatives of health 
                professionals;
                    (C) representatives of schools of medicine, 
                osteopathy, nursing, dentistry, optometry, pharmacy, 
                chiropractic, allied health, educational programs for 
                public health professionals, behavioral and mental 
                health professionals (as so defined), social workers, 
                pharmacists, physical therapists, oral health care 
                industry dentistry and dental hygiene, and physician 
                assistants;
                    (D) representatives of public and private teaching 
                hospitals, and ambulatory health facilities, including 
                Federal medical facilities; and
                    (E) any other health professional the Comptroller 
                General of the United States determines appropriate.
    (j) Reimbursement of Costs.--The Commission shall reimburse the 
Government Accountability Office for the full cost of carrying out its 
activities under this section as billed therefore by the Comptroller 
General of the United States. Such reimbursements shall be credited to 
the appropriation account ``Salaries and Expenses, Government 
Accountability Office'' current when the payment is received and remain 
available until expended.

SEC. 412. STATE HEALTH CARE WORKFORCE DEVELOPMENT GRANTS.

    (a) Establishment.--There is established a competitive health care 
workforce development grant program (referred to in this section as the 
``program'') for the purpose of enabling State partnerships to complete 
comprehensive planning and to carry out activities leading to coherent 
and comprehensive health care workforce development strategies at the 
State and local levels.
    (b) Assessment and Reporting.--
            (1) Duties of commission.--The National Health Care 
        Workforce Commission established in section 411 (referred to in 
        this section as the ``Commission'') shall--
                    (A) in collaboration with the Department of Labor 
                and in coordination with the Department of Education 
                and other relevant Federal agencies, make 
                recommendations to the fiscal and administrative agent 
                under paragraph (2) for grant recipients;
                    (B) assess the implementation of the grants; and
                    (C) collect performance and report information, 
                including identified models and best practices, on 
                grants from the fiscal and administrative agent and 
                distribute this information to Congress, relevant 
                Federal agencies, and to the public.
            (2) Fiscal and administrative agent.--The Health Resources 
        and Services Administration of the Department of Health and 
        Human Services (referred to in this section as the 
        ``Administration'') shall be the fiscal and administrative 
        agent for the grants awarded under this section. The 
        Administration is authorized to carry out the program, in 
        consultation with the Commission, which shall review reports on 
        the development, implementation, and evaluation activities of 
        the grant program, including--
                    (A) administering the grants;
                    (B) providing technical assistance to grantees; and
                    (C) reporting performance information to the 
                Commission.
    (c) Planning Grants.--
            (1) Amount and duration.--A planning grant shall be awarded 
        under this subsection for a period of not more than one year 
        and the maximum award may not be more than $150,000.
            (2) Eligibility.--To be eligible to receive a planning 
        grant, an entity shall be an eligible partnership. An eligible 
        partnership shall be a State workforce investment board, if it 
        includes or modifies the members to include at least one 
        representative from each of the following: health care 
        employer, labor organization, a public 2-year institution of 
        higher education, a public 4-year institution of higher 
        education, the recognized State federation of labor, the State 
        public secondary education agency, the State P-16 or P-20 
        Council if such a council exists, and a philanthropic 
        organization that is actively engaged in providing learning, 
        mentoring, and work opportunities to recruit, educate, and 
        train individuals for, and retain individuals in, careers in 
        health care and related industries.
            (3) Fiscal and administrative agent.--The Governor of the 
        State receiving a planning grant has the authority to appoint a 
        fiscal and an administrative agency for the partnership.
            (4) Application.--Each State partnership desiring a 
        planning grant shall submit an application to the Administrator 
        of the Administration at such time and in such manner, and 
        accompanied by such information as the Administrator may 
        reasonable require. Each application submitted for a planning 
        grant shall describe the members of the State partnership, the 
        activities for which assistance is sought, the proposed 
        performance benchmarks to be used to measure progress under the 
        planning grant, a budget for use of the funds to complete the 
        required activities described in paragraph (5), and such 
        additional assurance and information as the Administrator 
        determines to be essential to ensure compliance with the grant 
        program requirements.
            (5) Required activities.--A State partnership receiving a 
        planning grant shall carry out the following:
                    (A) Analyze State labor market information in order 
                to create health care career pathways for students and 
                adults.
                    (B) Identify current and projected high demand 
                State or regional health care sectors for purposes of 
                planning career pathways.
                    (C) Identify existing Federal, State, and private 
                resources to recruit, educate or train, and retain a 
                skilled health care workforce and strengthen 
                partnerships.
                    (D) Describe the academic and health care industry 
                skill standards for high school graduation, for entry 
                into postsecondary education, and for various 
                credentials and licensure.
                    (E) Describe State secondary and postsecondary 
                education and training policies, models, or practices 
                for the health care sector, including career 
                information and guidance counseling.
                    (F) Identify Federal or State policies or rules to 
                developing a coherent and comprehensive health care 
                workforce development strategy and barriers and a plan 
                to resolve these barriers.
                    (G) Participate in the Administration's evaluation 
                and reporting activities.
            (6) Performance and evaluation.--Before the State 
        partnership receives a planning grant, such partnership and the 
        Administrator of the Administration shall jointly determine the 
        performance benchmarks that will be established for the 
        purposes of the planning grant.
            (7) Match.--Each State partnership receiving a planning 
        grant shall provide an amount, in cash or in kind, that is not 
        less that 15 percent of the amount of the grant, to carry out 
        the activities supported by the grant. The matching requirement 
        may be provided from funds available under other Federal, 
        State, local or private sources to carry out the activities.
            (8) Report.--
                    (A) Report to administration.--Not later than 1 
                year after a State partnership receives a planning 
                grant, the partnership shall submit a report to the 
                Administration on the State's performance of the 
                activities under the grant, including the use of funds, 
                including matching funds, to carry out required 
                activities, and a description of the progress of the 
                State workforce investment board in meeting the 
                performance benchmarks.
                    (B) Report to congress.--The Administration shall 
                submit a report to Congress analyzing the planning 
                activities, performance, and fund utilization of each 
                State grant recipient, including an identification of 
                promising practices and a profile of the activities of 
                each State grant recipient.
    (d) Implementation Grants.--
            (1) In general.--The Administration shall--
                    (A) competitively award implementation grants to 
                State partnerships to enable such partnerships to 
                implement activities that will result in a coherent and 
                comprehensive plan for health workforce development 
                that will address current and projected workforce 
                demands within the State; and
                    (B) inform the Commission and Congress about the 
                awards made.
            (2) Duration.--An implementation grant shall be awarded for 
        a period of no more than 2 years, except in those cases where 
        the Administration determines that the grantee is high 
        performing and the activities supported by the grant warrant up 
        to 1 additional year of funding.
            (3) Eligibility.--To be eligible for an implementation 
        grant, a State partnership shall have--
                    (A) received a planning grant under subsection (c) 
                and completed all requirements of such grant; or
                    (B) completed a satisfactory application, including 
                a plan to coordinate with required partners and 
                complete the required activities during the 2 year 
                period of the implementation grant.
            (4) Fiscal and administrative agent.--A State partnership 
        receiving an implementation grant shall appoint a fiscal and an 
        administration agent for the implementation of such grant.
            (5) Application.--Each eligible State partnership desiring 
        an implementation grant shall submit an application to the 
        Administration at such time, in such manner, and accompanied by 
        such information as the Administration may reasonably require. 
        Each application submitted shall include--
                    (A) a description of the members of the State 
                partnership;
                    (B) a description of how the State partnership 
                completed the required activities under the planning 
                grant, if applicable;
                    (C) a description of the activities for which 
                implementation grant funds are sought, including grants 
                to regions by the State partnership to advance coherent 
                and comprehensive regional health care workforce 
                planning activities;
                    (D) a description of how the State partnership will 
                coordinate with required partners and complete the 
                required partnership activities during the duration of 
                an implementation grant.
                    (E) a budget proposal of the cost of the activities 
                supported by the implementation grant and a timeline 
                for the provision of matching funds required;
                    (F) proposed performance benchmarks to be used to 
                assess and evaluate the progress of the partnership 
                activities;
                    (G) a description of how the State partnership will 
                collect data to report progress in grant activities; 
                and
                    (H) such additional assurances as the 
                Administration determines to be essential to ensure 
                compliance with grant requirements.
            (6) Required activities.--
                    (A) In general.--A State partnership that receives 
                an implementation grant may reserve not less than 60 
                percent of the grant funds to make grants to be 
                competitively awarded by the State partnership, 
                consistent with State procurement rules, to encourage 
                regional partnerships to address health care workforce 
                development needs and to promote innovative health care 
                workforce career pathway activities, including career 
                counseling, learning, and employment.
                    (B) Eligible partnership duties.--An eligible State 
                partnership receiving an implementation grant shall--
                            (i) identify and convene regional 
                        leadership to discuss opportunities to engage 
                        in statewide health care workforce development 
                        planning, including potential use of grants to 
                        be competitively awarded by the State 
                        partnership to encourage innovative approaches 
                        to improving the supply, diversity, 
                        distribution, and development of regional 
                        health care workforces, including the alignment 
                        of curricula (and prerequisites) for health 
                        care careers, the expansion of and access to 
                        quality and timely career information and 
                        guidance, and education and training programs;
                            (ii) in consultation with key stakeholders 
                        and regional leaders, take appropriate steps to 
                        reduce Federal, State, or local barriers to a 
                        comprehensive and coherent strategy, including 
                        changes in State or local policies to foster 
                        coherent and comprehensive health care 
                        workforce development activities, including 
                        health care career pathways at the State and 
                        regional levels and career planning 
                        information, and as appropriate, requests for 
                        Federal program or administrative waivers;
                            (iii) develop and disseminate a preliminary 
                        statewide strategy that addresses short- and 
                        long-term health care workforce development 
                        supply versus demand, including the 
                        solicitation of comments or feedback from key 
                        stakeholders and the general public, and refine 
                        accordingly;
                            (iv) convene State partnership members on a 
                        regular basis, and at least on a semiannual 
                        basis;
                            (v) assist leaders at the regional level to 
                        form partnerships, including the provision of 
                        technical assistance and capacity building 
                        activities such as the dissemination of best 
                        practices and tools within the State;
                            (vi) collect and assess data on and report 
                        on the performance benchmarks selected by the 
                        State partnership and the Administration for 
                        implementation activities carried out by 
                        regional and State partnerships; and
                            (vii) participate in the Administration's 
                        evaluation and reporting activities.
            (7) Performance and evaluation.--Before the State 
        partnership receives an implementation grant, it and the 
        Administrator shall jointly determine the performance 
        benchmarks that shall be established for the purposes of the 
        implementation grant.
            (8) Match.--Each State partnership receiving an 
        implementation grant shall provide an amount, in cash or in 
        kind that is not less than 25 percent of the amount of the 
        grant, to carry out the activities supported by the grant. The 
        matching funds may be provided from funds available from other 
        Federal, State, local, or private sources to carry out such 
        activities.
            (9) Reports.--
                    (A) Report to administration.--For each year of the 
                implementation grant, the State partnership receiving 
                the implementation grant shall submit a report to the 
                Administration on the performance of the State of the 
                grant activities, including a description of the use of 
                the funds, including matched funds, to complete 
                activities, and a description of the performance of the 
                State partnership in meeting the performance 
                benchmarks.
                    (B) Report to congress.--The Administration shall 
                submit a report to Congress analyzing implementation 
                activities, performance, and fund utilization of the 
                State grantees, including an identification of 
                promising practices and a profile of the activities of 
                each State grantee.
    (e) Authorization for Appropriations.--
            (1) Planning grants.--There are authorized to be 
        appropriated to award planning grants under subsection (c) 
        $8,000,000 for fiscal year 2010, and such sums as may be 
        necessary for each subsequent fiscal year.
            (2) Implementation grants.--There are authorized to be 
        appropriated to award implementation grants under subsection 
        (d), $150,000,000 for fiscal year 2010, and such sums as may be 
        necessary for each subsequent fiscal year.

SEC. 413. HEALTH CARE WORKFORCE PROGRAM ASSESSMENT.

    (a) In General.--Section 761 of the Public Health Service Act (42 
U.S.C. 294m) is amended--
            (1) by redesignating subsection (c) as subsection (e);
            (2) by striking subsection (b) and inserting the following:
    ``(b) National Center for Health Care Workforce Analysis.--
            ``(1) Establishment.--The Secretary shall establish the 
        National Center for Health Workforce Analysis (referred to in 
        this section as the `National Center').
            ``(2) Purposes.--The purposes of the National Center are 
        to--
                    ``(A) provide for the development of information 
                describing the health care workforce and the analysis 
                of health care workforce related issues;
                    ``(B) carry out the activities under section 
                792(a); and
                    ``(C) collect, analyze, and report data related to 
                programs under this title in coordination with the 
                State and Regional Centers for Health Workforce 
                Analysis described in subsection (c) (referred to in 
                this section as the `State and Regional Centers') and 
                with the State agency responsible for the statewide 
                employment statistics system under section 15(e) of the 
                Wagner-Peyser Act (29 U.S.C. 49l-2).
            ``(3) Functions.--The National Center shall, in 
        coordination with the Commission established in section 411 of 
        the Affordable Health Choices Act--
                    ``(A) annually evaluate the effectiveness of 
                programs under this title;
                    ``(B) develop and publish benchmarks for 
                performance for programs under this title;
                    ``(C) establish, maintain, and make publicly 
                available through the Internet a national health 
                workforce database to collect data from--
                            ``(i) longitudinal evaluations (as 
                        described in subsection (d)(2) on performance 
                        measures (as developed under sections 
                        749(d)(3), 757(d)(3), and 762(a)(3)); and
                            ``(ii) the State and Regional Centers 
                        described in subsection (c); and
                    ``(D) and establish and maintain a registry of each 
                grant awarded under this title.
            ``(4) Collaboration and data sharing.--
                    ``(A) In general.--The National Center shall 
                collaborate with Federal agencies, health professions 
                education organizations, health professions 
                organizations, and professional medical societies for 
                the purpose of linking data regarding grants awarded 
                under this title with 1 or more of the following:
                            ``(i) Data maintained by the Department of 
                        Health and Human Services and its various 
                        agencies.
                            ``(ii) Data maintained by the Bureau of 
                        Labor Statistics.
                            ``(iii) Data maintained by the Census 
                        Bureau.
                            ``(iv) Data maintained by the Departments 
                        of Defense and Veterans Affairs.
                            ``(v) Data sets maintained by health 
                        professions education organizations, health 
                        professions organizations, or professional 
                        medical societies.
                            ``(vi) Other data sets, as the Secretary 
                        determines appropriate.
                    ``(B) Contracts for health workforce analysis.--For 
                the purpose of carrying out the activities described in 
                subparagraph (A), the National Center may enter into 
                contracts with health professions education 
                organizations, health professions organizations, or 
                professional medical societies.
    ``(c) State and Regional Centers for Health Workforce Analysis.--
            ``(1) In general.--The Secretary shall award grants to, or 
        enter into contracts with, eligible entities for purposes of--
                    ``(A) collecting, analyzing, and reporting to the 
                National Center data regarding programs under this 
                title;
                    ``(B) conducting and broadly disseminating research 
                and reports on State, regional, and national health 
                workforce issues;
                    ``(C) evaluating the effectiveness of programs 
                under this title; and
                    ``(D) providing technical assistance to local and 
                regional entities on the collection, analysis, and 
                reporting of data related to health workforce issues.
            ``(2) Eligible entities.--To be eligible for a grant or 
        contract under this subsection, an entity shall--
                    ``(A) be a State (including a State Office of Rural 
                Health), a State workforce investment board, a public 
                health or health professions school, an academic health 
                center (including an area health education center 
                program), or an appropriate public or private nonprofit 
                entity or a partnership of such entities, such as a 
                community college system; and
                    ``(B) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require.
    ``(d) Increase in Grants for Longitudinal Evaluations.--
            ``(1) In general.--The Secretary shall increase the amount 
        of a grant or contract awarded to an eligible entity under this 
        title for the establishment and maintenance of a longitudinal 
        evaluation of students, residents, fellows, interns, or faculty 
        who have received education, training, or financial assistance 
        from programs under this title.
            ``(2) Capability.--A longitudinal evaluation shall be 
        capable of--
                    ``(A) studying participation in the National Health 
                Service Corps, practice in federally qualified health 
                centers, practice in health professional shortage areas 
                and medically underserved areas, and practice in 
                primary care; and
                    ``(B) collecting and reporting data on performance 
                measures developed under sections 749(d)(3), 757(d)(3), 
                and 762(a)(3).
            ``(3) Guidelines.--A longitudinal evaluation shall comply 
        with guidelines issued under sections 749(d)(4), 757(d)(4), and 
        762(a)(4).
            ``(4) Eligible entities.--To be eligible to obtain an 
        increase under this section, an entity shall be a recipient of 
        a grant or contract under this title and have not previously 
        received an increase under this section.''; and
            (3) in subsection (e), as so redesignated--
                    (A) by striking paragraph (1) and inserting the 
                following:
            ``(1) In general.--
                    ``(A) National center for health workforce 
                analysis.--To carry out subsection (b), there are 
                authorized to be appropriated $5,000,000 for each of 
                fiscal years 2010 and 2011, $10,000,000 for each of 
                fiscal years 2012 through 2014, and such sums as may be 
                necessary for each subsequent fiscal year.
                    ``(B) State and regional centers.--To carry out 
                subsection (c), there are authorized to be appropriated 
                $4,500,000 for each of fiscal years 2010 through 2014, 
                and such sums as may be necessary for each subsequent 
                fiscal year.
                    ``(C) Grants for longitudinal evaluations.--To 
                carry out subsection (d), there are authorized to be 
                appropriated such sums as may be necessary for fiscal 
                years 2010 through 2014.
                    ``(D) Carryover funds.--An entity that receives an 
                award under this section may carry over funds from 1 
                fiscal year to another without obtaining approval from 
                the Secretary. In no case may any funds be carried over 
                pursuant to the preceding sentence for more than 3 
                years.''; and
            (4) in paragraph (2), by striking ``subsection (a)'' and 
        inserting ``paragraph (1)''.
    (b) Transfer of Functions.--Not later than 180 days after the date 
of enactment of this Act, all of the functions, authorities, and 
resources of the National Center for Health Workforce Analysis of the 
Health Resources and Services Administration, as in effect on the date 
before the date of enactment of this Act, shall be transferred to the 
National Center for Health Workforce Analysis established under section 
761 of the Public Health Service Act, as amended by subsection (a).
    (c) Priority for Use of Longitudinal Evaluations.--Section 
791(a)(1) of the Public Health Service Act (42 U.S.C. 295j(a)(1)) is 
amended--
            (1) in subparagraph (A), by striking ``or'' at the end;
            (2) in subparagraph (B), by striking the period and 
        inserting ``; or''; and
            (3) by adding at the end the following:
                    ``(C) utilizes a longitudinal evaluation (as 
                described in section 761(d)(2)) and reports data from 
                such system to the national workforce database (as 
                established under section 761(b)(3)(D)).''.
    (d) Performance Measures; Guidelines for Longitudinal 
Evaluations.--
            (1) Advisory committee on training in primary care medicine 
        and dentistry.--Section 748(d) of the Public Health Service Act 
        is amended--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following:
            ``(3) not later than 3 years after the date of enactment of 
        the Affordable Health Choices Act, develop, publish, and 
        implement performance measures, which shall be quantitative to 
        the extent possible, for programs under this part;
            ``(4) develop and publish guidelines for longitudinal 
        evaluations (as described in section 761(d)(2)) for programs 
        under this part; and
            ``(5) recommend appropriation levels for programs under 
        this part.''.
            (2) Advisory committee on interdisciplinary, community-
        based linkages.--Section 756(d) of the Public Health Service 
        Act is amended--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following:
            ``(3) not later than 3 years after the date of enactment of 
        the Affordable Health Choices Act, develop, publish, and 
        implement performance measures, which shall be quantitative to 
        the extent possible, for programs under this part;
            ``(4) develop and publish guidelines for longitudinal 
        evaluations (as described in section 761(d)(2)) for programs 
        under this part; and
            ``(5) recommend appropriation levels for programs under 
        this part.''.
            (3) Advisory council on graduate medical education.--
        Section 762(a) of the Public Health Service Act (42 U.S.C. 
        294o(a)) is amended--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following:
            ``(3) not later than 3 years after the date of enactment of 
        the Affordable Health Choices Act develop, publish, and 
        implement performance measures, which shall be quantitative to 
        the extent possible, for programs under this title, except for 
        programs under part C or D;
            ``(4) develop and publish guidelines for longitudinal 
        evaluations (as described in section 761(d)(2)) for programs 
        under this title, except for programs under part C or D; and
            ``(5) recommend appropriation levels for programs under 
        this title, except for programs under part C or D.''.

     Subtitle C--Increasing the Supply of the Health Care Workforce

SEC. 421. FEDERALLY SUPPORTED STUDENT LOAN FUNDS.

    (a) Medical Schools and Primary Health Care.--Section 723 of the 
Public Health Service Act (42 U.S.C. 292s) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking subparagraph (B) 
                and inserting the following:
                    ``(B) to practice in such care for 10 years 
                (including residency training in primary health care) 
                or through the date on which the loan is repaid in 
                full, whichever occurs first.''; and
                    (B) by striking paragraph (3) and inserting the 
                following:
            ``(3) Noncompliance by student.--Each agreement entered 
        into with a student pursuant to paragraph (1) shall provide 
        that, if the student fails to comply with such agreement, the 
        loan involved will begin to accrue interest at a rate of 2 
        percent per year greater than the rate at which the student 
        would pay if compliant in such year.''; and
            (2) by adding at the end the following:
    ``(d) Sense of Congress.--It is the sense of Congress that funds 
repaid under the loan program under this section should not be 
transferred to the Treasury of the United States or otherwise used for 
any other purpose other than to carry out this section.''.
    (b) Student Loan Guidelines.--The Secretary of Health and Human 
Services shall not require parental financial information for an 
independent student to determine financial need under section 723 of 
the Public Health Service Act (42 U.S.C. 292s) and the determination of 
need for such information shall be at the discretion of applicable 
school loan officer. The Secretary shall amend guidelines issued by the 
Health Resources and Services Administration in accordance with the 
preceding sentence.

SEC. 422. NURSING STUDENT LOAN PROGRAM.

    (a) Loan Agreements.--Section 836(a) of the Public Health Service 
Act (42 U.S.C. 297b(a)) is amended--
            (1) by striking ``$2,500'' and inserting ``$3,300'';
            (2) by striking ``$4,000'' and inserting ``$5,200''; and
            (3) by striking ``$13,000'' and all that follows through 
        the period and inserting ``$17,000 in the case of any student 
        during fiscal years 2010 and 2011. After fiscal year 2011, such 
        amounts shall be adjusted to provide for a cost-of-attendance 
        increase for the yearly loan rate and the aggregate of the 
        loans.''.
    (b) Loan Provisions.--Section 836(b) of the Public Health Service 
Act (42 U.S.C. 297b(b)) is amended--
            (1) in paragraph (1)(C), by striking ``1986'' and inserting 
        ``2000''; and
            (2) in paragraph (3), by striking ``the date of enactment 
        of the Nurse Training Amendments of 1979'' and inserting 
        ``September 29, 1995''.

SEC. 423. HEALTH CARE WORKFORCE LOAN REPAYMENT PROGRAMS.

    Part E of title VII of the Public Health Service Act (42 U.S.C. 
294n et seq.) is amended by adding at the end the following:

            ``Subpart 3--Recruitment and Retention Programs

``SEC. 775. INVESTMENT IN TOMORROW'S PEDIATRIC HEALTH CARE WORKFORCE.

    ``(a) Establishment.--The Secretary shall establish and carry out a 
pediatric specialty loan repayment program under which the eligible 
individual agrees to be employed full-time for a specified period 
(which shall not be less than 2 years) in providing pediatric medical 
subspecialty, pediatric surgical specialty, or child and adolescent 
mental and behavioral health care, including substance abuse prevention 
and treatment services.
    ``(b) Program Administration.--Through the program established 
under this section, the Secretary shall enter into contracts with 
qualified health professionals under which--
            ``(1) such qualified health professionals will agree to 
        provide pediatric medical subspecialty, pediatric surgical 
        specialty, or child and adolescent mental and behavioral health 
        care in an area with a shortage of the specified pediatric 
        subspecialty that has a sufficient pediatric population to 
        support such pediatric subspecialty, as determined by the 
        Secretary; and
            ``(2) the Secretary agrees to make payments on the 
        principal and interest of undergraduate, graduate, or graduate 
        medical education loans of professionals described in paragraph 
        (1) of not more than $35,000 a year for each year of agreed 
        upon service under such paragraph for a period of not more than 
        3 years during the qualified health professional's--
                    ``(A) participation in an accredited pediatric 
                medical subspecialty, pediatric surgical specialty, or 
                child and adolescent mental health subspecialty 
                residency or fellowship; or
                    ``(B) employment as a pediatric medical 
                subspecialist, pediatric surgical specialist, or child 
                and adolescent mental health professional serving an 
                area or population described in such paragraph.
    ``(c) In General.--
            ``(1) Eligible individuals.--
                    ``(A) Pediatric medical specialists and pediatric 
                surgical specialists.--For purposes of contracts with 
                respect to pediatric medical specialists and pediatric 
                surgical specialists, the term `qualified health 
                professional' means a licensed physician who--
                            ``(i) is entering or receiving training in 
                        an accredited pediatric medical subspecialty or 
                        pediatric surgical specialty residency or 
                        fellowship; or
                            ``(ii) has completed (but not prior to the 
                        end of the calendar year in which this section 
                        is enacted) the training described in 
                        subparagraph (B).
                    ``(B) Child and adolescent mental and behavioral 
                health.--For purposes of contracts with respect to 
                child and adolescent mental and behavioral health care, 
                the term `qualified health professional' means a health 
                care professional who--
                            ``(i) has received specialized training or 
                        clinical experience in child and adolescent 
                        mental health in psychiatry, psychology, school 
                        psychology, behavioral pediatrics, psychiatric 
                        nursing, social work, school social work, 
                        substance abuse disorder prevention and 
                        treatment, marriage and family therapy, school 
                        counseling, or professional counseling;
                            ``(ii) has a license or certification in a 
                        State to practice allopathic medicine, 
                        osteopathic medicine, psychology, school 
                        psychology, psychiatric nursing, social work, 
                        school social work, marriage and family 
                        therapy, school counseling, or professional 
                        counseling; or
                            ``(iii) is a mental health service 
                        professional who completed (but not before the 
                        end of the calendar year in which this section 
                        is enacted) specialized training or clinical 
                        experience in child and adolescent mental 
                        health described in clause (i).
            ``(2) Additional eligibility requirements.--The Secretary 
        may not enter into a contract under this subsection with an 
        eligible individual unless--
                    ``(A) the individual agrees to work in, or for a 
                provider serving, a health professional shortage area 
                or medically underserved area, or to serve a medically 
                underserved population;
                    ``(B) the individual is a United States citizen or 
                a permanent legal United States resident; and
                    ``(C) if the individual is enrolled in a graduate 
                program, the program is accredited, and the individual 
                has an acceptable level of academic standing (as 
                determined by the Secretary).
    ``(d) Priority.--In entering into contracts under this subsection, 
the Secretary shall give priority to applicants who--
            ``(1) are or will be working in a school or other pre-
        kindergarten, elementary, or secondary education setting;
            ``(2) have familiarity with evidence-based methods and 
        cultural and linguistic competence health care services; and
            ``(3) demonstrate financial need.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated $30,000,000 for each of fiscal years 2010 through 2014 to 
carry out subsection (c)(1)(A) and $20,000,000 for each of fiscal years 
2010 through 2013 to carry out subsection (c)(1)(B).''.

SEC. 424. PUBLIC HEALTH WORKFORCE RECRUITMENT AND RETENTION PROGRAMS.

    Part E of title VII of the Public Health Service Act (42 U.S.C. 
294n et seq.), as amended by section 423, is further amended by adding 
at the end the following:

``SEC. 776. PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM.

    ``(a) Establishment.--The Secretary shall establish the Public 
Health Workforce Loan Repayment Program (referred to in this section as 
the `Program') to assure an adequate supply of public health 
professionals to eliminate critical public health workforce shortages 
in Federal, State, local, and tribal public health agencies.
    ``(b) Eligibility.--To be eligible to participate in the Program, 
an individual shall--
            ``(1)(A) be accepted for enrollment, or be enrolled, as a 
        student in an accredited academic educational institution in a 
        State or territory in the final year of a course of study or 
        program leading to a public health or health professions degree 
        or certificate; and have accepted employment with a Federal, 
        State, local, or tribal public health agency, or a related 
        training fellowship, as recognized by the Secretary, to 
        commence upon graduation;
            ``(B)(i) have graduated, during the preceding 10-year 
        period, from an accredited educational institution in a State 
        or territory and received a public health or health professions 
        degree or certificate; and
            ``(ii) be employed by, or have accepted employment with, a 
        Federal, State, local, or tribal public health agency or a 
        related training fellowship, as recognized by the Secretary;
            ``(2) be a United States citizen; and
            ``(3)(A) submit an application to the Secretary to 
        participate in the Program;
            ``(B) execute a written contract as required in subsection 
        (c); and
            ``(4) not have received, for the same service, a reduction 
        of loan obligations under section 455(m), 428J, 428K, 428L, or 
        460 of the Higher Education Act of 1965.
    ``(c) Contract.--The written contract (referred to in this section 
as the `written contract') between the Secretary and an individual 
shall contain--
            ``(1) an agreement on the part of the Secretary that the 
        Secretary will repay on behalf of the individual loans incurred 
        by the individual in the pursuit of the relevant degree or 
        certificate in accordance with the terms of the contract;
            ``(2) an agreement on the part of the individual that the 
        individual will serve in the full-time employment of a Federal, 
        State, local, or tribal public health agency or a related 
        fellowship program in a position related to the course of study 
        or program for which the contract was awarded for a period of 
        time (referred to in this section as the `period of obligated 
        service') equal to the greater of--
                    ``(A) 3 years; or
                    ``(B) such longer period of time as determined 
                appropriate by the Secretary and the individual;
            ``(3) an agreement, as appropriate, on the part of the 
        individual to relocate to a priority service area (as 
        determined by the Secretary) in exchange for an additional loan 
        repayment incentive amount to be determined by the Secretary;
            ``(4) a provision that any financial obligation of the 
        United States arising out of a contract entered into under this 
        section and any obligation of the individual that is 
        conditioned thereon, is contingent on funds being appropriated 
        for loan repayments under this section;
            ``(5) a statement of the damages to which the United States 
        is entitled, under this section for the individual's breach of 
        the contract; and
            ``(6) such other statements of the rights and liabilities 
        of the Secretary and of the individual, not inconsistent with 
        this section.
    ``(d) Payments.--
            ``(1) In general.--A loan repayment provided for an 
        individual under a written contract under the Program shall 
        consist of payment, in accordance with paragraph (2), on behalf 
        of the individual of the principal, interest, and related 
        expenses on government and commercial loans received by the 
        individual regarding the undergraduate or graduate education of 
        the individual (or both), which loans were made for tuition 
        expenses incurred by the individual.
            ``(2) Payments for years served.--For each year of 
        obligated service that an individual contracts to serve under 
        subsection (c) the Secretary may pay up to $35,000 on behalf of 
        the individual for loans described in paragraph (1). With 
        respect to participants under the Program whose total eligible 
        loans are less than $105,000, the Secretary shall pay an amount 
        that does not exceed \1/3\ of the eligible loan balance for 
        each year of obligated service of the individual.
            ``(3) Tax liability.--For the purpose of providing 
        reimbursements for tax liability resulting from payments under 
        paragraph (2) on behalf of an individual, the Secretary shall, 
        in addition to such payments, make payments to the individual 
        in an amount not to exceed 39 percent of the total amount of 
        loan repayments made for the taxable year involved.
    ``(e) Postponing Obligated Service.--With respect to an individual 
receiving a degree or certificate from a health professions or other 
related school, the date of the initiation of the period of obligated 
service may be postponed as approved by the Secretary.
    ``(f) Breach of Contract.--An individual who fails to comply with 
the contract entered into under subsection (c) shall be subject to the 
same financial penalties as provided for under section 338E for 
breaches of loan repayment contracts under section 338B.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $195,000,000 for fiscal year 
2010, and such sums as may be necessary for each of fiscal years 2011 
through 2015.''.

SEC. 425. ALLIED HEALTH WORKFORCE RECRUITMENT AND RETENTION PROGRAMS.

    (a) Purpose.--The purpose of this section is to assure an adequate 
supply of allied health professionals to eliminate critical allied 
health workforce shortages in Federal, State, local, and tribal public 
health agencies or in settings where patients might require health care 
services, including acute care facilities, ambulatory care facilities, 
personal residences and other settings, as recognized by the Secretary 
of Health and Human Services by authorizing an Allied Health Loan 
Forgiveness Program.
    (b) Allied Health Workforce Recruitment and Retention Program.--
Section 428K of the Higher Education Act of 1965 (20 U.S.C. 1078-11) is 
amended--
            (1) in subsection (b), by adding at the end the following:
            ``(18) Allied health professionals.--The individual is 
        employed full-time as an allied health professional--
                    ``(A) in a Federal, State, local, or tribal public 
                health agency; or
                    ``(B) in a setting where patients might require 
                health care services, including acute care facilities, 
                ambulatory care facilities, personal residences and 
                other settings located in health professional shortage 
                areas, medically underserved areas, or medically 
                underserved populations, as recognized by the Secretary 
                of Health and Human Services.''; and
            (2) in subsection (g)--
                    (A) by redesignating paragraphs (1) through (9) as 
                paragraphs (2) through (10), respectively; and
                    (B) by inserting before paragraph (2) (as 
                redesignated by subparagraph (A)) the following:
            ``(1) Allied health professional.--The term `allied health 
        professional' means an allied health professional as defined in 
        section 799B(5) of the Public Heath Service Act (42 U.S.C. 
        295p(5)) who--
                    ``(A) has graduated and received an allied health 
                professions degree or certificate from an institution 
                of higher education; and
                    ``(B) is employed with a Federal, State, local or 
                tribal public health agency, or in a setting where 
                patients might require health care services, including 
                acute care facilities, ambulatory care facilities, 
                personal residences and other settings located in 
                health professional shortage areas, medically 
                underserved areas, or medically underserved 
                populations, as recognized by the Secretary of Health 
                and Human Services.''.

SEC. 426. GRANTS FOR STATE AND LOCAL PROGRAMS.

    (a) In General.--Section 765(d) of the Public Health Service Act 
(42 U.S.C. 295(d)) is amended--
            (1) in paragraph (7), by striking ``; or'' and inserting a 
        semicolon;
            (2) by redesignating paragraph (8) as paragraph (9); and
            (3) by inserting after paragraph (7) the following:
            ``(8) public health workforce loan repayment programs; 
        or''.
    (b) Training for Mid-career Public Health Professionals.--Part E of 
title VII of the Public Health Service Act (42 U.S.C. 294n et seq.), as 
amended by section 424, is further amended by adding at the end the 
following:

``SEC. 777. TRAINING FOR MID-CAREER PUBLIC AND ALLIED HEALTH 
              PROFESSIONALS.

    ``(a) In General.--The Secretary may make grants to, or enter into 
contracts with, any eligible entity to award scholarships to eligible 
individuals to enroll in degree or professional training programs for 
the purpose of enabling mid-career professionals in the public health 
and allied health workforce to receive additional training in the field 
of public health and allied health.
    ``(b) Eligibility.--
            ``(1) Eligible entity.--The term `eligible entity' 
        indicates an accredited educational institution that offers a 
        course of study, certificate program, or professional training 
        program in public or allied health or a related discipline, as 
        determined by the Secretary
            ``(2) Eligible individuals.--The term `eligible 
        individuals' includes those individuals employed in public and 
        allied health positions at the Federal, State, tribal, or local 
        level who are interested in retaining or upgrading their 
        education.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $60,000,000 for fiscal year 
2010 and such sums as may be necessary for each of fiscal years 2011 
through 2015. Fifty percent of appropriated funds shall be allotted to 
public health mid-career professionals and 50 percent shall be allotted 
to allied health mid-career professionals.''.

SEC. 427. FUNDING FOR NATIONAL HEALTH SERVICE CORPS.

    Section 338H(a) of the Public Health Service Act (42 U.S.C. 
254q(a)) is amended to read as follows:
    ``(a) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated, out of any 
funds in the Treasury not otherwise appropriated, the following:
            ``(1) For fiscal year 2010, $320,461,632.
            ``(2) For fiscal year 2011, $414,095,394.
            ``(3) For fiscal year 2012, $535,087,442.
            ``(4) For fiscal year 2013, $691,431,432.
            ``(5) For fiscal year 2014, $893,456,433.
            ``(6) For fiscal year 2015, $1,154,510,336.
            ``(7) For fiscal year 2016, and each subsequent fiscal 
        year, the amount appropriated for the preceding fiscal year 
        adjusted by the product of--
                    ``(A) one plus the average percentage increase in 
                the costs of health professions education during the 
                prior fiscal year; and
                    ``(B) one plus the average percentage change in the 
                number of individuals residing in health professions 
                shortage areas designated under section 333 during the 
                prior fiscal year, relative to the number of 
                individuals residing in such areas during the previous 
                fiscal year.''. [NOTE: this section is the same as 
                section 173 of title I.]

SEC. 428. NURSE-MANAGED HEALTH CLINICS.

    (a) Purpose.--The purpose of this section is to fund the 
development and operation of nurse-managed health clinics in order to 
provide comprehensive primary health care and wellness services to 
vulnerable populations living in the Nation's medically underserved 
communities, and to reduce the level of health disparities experienced 
by vulnerable populations.
    (b) Grants.--Subpart 1 of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended by inserting after 
section 330A the following:

``SEC. 330A-1. GRANTS TO NURSE-MANAGED HEALTH CLINICS.

    ``(a) Definitions.--
            ``(1) Comprehensive primary health care services.--In this 
        section, the term `comprehensive primary health care services' 
        means the primary health services described in section 
        330(b)(1).
            ``(2) Nurse-managed health clinic.--The term `nurse-managed 
        health clinic' means a nurse-practice arrangement, managed by 
        advanced practice nurses, that provides primary care or 
        wellness services to underserved or vulnerable populations and 
        that is associated with a school, college, university or 
        department of nursing, federally qualified health center, or 
        independent nonprofit health or social services agency.
    ``(b) Authority to Award Grants.--The Secretary shall award grants 
for the cost of the operation of nurse-managed health clinics that meet 
the requirements of this section.
    ``(c) Applications.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be an NMHC; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing--
                    ``(A) assurances that nurses are the major 
                providers of services at the NMHC and that at least 1 
                advanced practice nurse holds an executive management 
                position within the organizational structure of the 
                NMHC;
                    ``(B) an assurance that the NMHC will continue 
                providing comprehensive primary health care services or 
                wellness services without regard to income or insurance 
                status of the patient for the duration of the grant 
                period; and
                    ``(C) an assurance that, not later than 90 days of 
                receiving a grant under this section, the NMHC will 
                establish a community advisory committee, for which a 
                majority of the members shall be individuals who are 
                served by the NMHC.
    ``(d) Grant Amount.--The amount of any grant made under this 
section for any fiscal year shall be determined by the Secretary, 
taking into account--
            ``(1) the financial need of the NMHC, considering State, 
        local, and other operational funding provided to the NMHC; and
            ``(2) other factors, as the Secretary determines 
        appropriate.
    ``(e) Authorization of Appropriations.--For the purposes of 
carrying out this section, there are authorized to be appropriated 
$50,000,000 for the fiscal year 2010 and such sums as may be necessary 
for each of the fiscal years 2011 through 2014.''.

SEC. 429. ELIMINATION OF CAP ON COMMISSIONED CORPS.

    Section 202 of the Department of Health and Human Services 
Appropriations Act, 1993 (Public Law 102-394) is amended by striking 
``not to exceed 2,800''.

SEC. 430. ESTABLISHING A READY RESERVE CORPS.

    Section 203 of the Public Health Service Act (42 U.S.C. 204) is 
amended to read as follows:

``SEC. 203. COMMISSIONED CORPS AND READY RESERVE CORPS.

    ``(a) Establishment.--
            ``(1) In general.--There shall be in the Service a 
        commissioned Regular Corps and a Ready Reserve Corps for 
        service in time of national emergency.
            ``(2) Requirement.--All commissioned officers shall be 
        citizens of the United States and shall be appointed without 
        regard to the civil-service laws and compensated without regard 
        to the Classification Act of 1923, as amended.
            ``(3) Appointment.--Commissioned officers of the Ready 
        Reserve Corps shall be appointed by the President and 
        commissioned officers of the Regular Corps shall be appointed 
        by the President with the advice and consent of the Senate.
            ``(4) Active duty.--Commissioned officers of the Ready 
        Reserve Corps shall at all times be subject to call to active 
        duty by the Surgeon General, including active duty for the 
        purpose of training.
            ``(5) Warrant officers.--Warrant officers may be appointed 
        to the Service for the purpose of providing support to the 
        health and delivery systems maintained by the Service and any 
        warrant officer appointed to the Service shall be considered 
        for purposes of this Act and title 37, United States Code, to 
        be a commissioned officer within the Commissioned Corps of the 
        Service.
    ``(b) Assimilating Reserve Corp Officers Into the Regular Corps.--
Effective on the date of enactment of the Affordable Health Choices 
Act, all individuals classified as officers in the Reserve Corps under 
this section (as such section existed on the day before the date of 
enactment of such Act) and serving on active duty shall be deemed to be 
commissioned officers of the Regular Corps.
    ``(c) Purpose and Use of Ready Research.--
            ``(1) Purpose.--The purpose of the Ready Reserve Corps is 
        to fulfill the need to have additional Commissioned Corps 
        personnel available on short notice (similar to the uniformed 
        service's reserve program) to assist regular Commissioned Corps 
        personnel to meet both routine public health and emergency 
        response missions.
            ``(2) Uses.--The Ready Reserve Corps shall--
                    ``(A) participate in routine training to meet the 
                general and specific needs of the Commissioned Corps;
                    ``(B) be available and ready for involuntary calls 
                to active duty during national emergencies and public 
                health crises, similar to the uniformed service reserve 
                personnel;
                    ``(C) be available for backfilling critical 
                positions left vacant during deployment of active duty 
                Commissioned Corps members, as well as for deployment 
                to respond to public health emergencies, both foreign 
                and domestic; and
                    ``(D) be available for service assignment in 
                isolated, hardship, and medically underserved 
                communities (as defined in section 799B) to improve 
                access to health services.
    ``(d) Funding.--For the purpose of carrying out the duties and 
responsibilities of the Commissioned Corps under this section, there 
are authorized to be appropriated $5,000,000 for each of fiscal years 
2010 through 2014 for recruitment and training and $12,500,000 for each 
of fiscal years 2010 through 2014 for the Ready Reserve Corps.''.

   Subtitle D--Enhancing Health Care Workforce Education and Training

SEC. 431. TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, 
              GENERAL PEDIATRICS, AND PHYSICIAN ASSISTANTSHIP.

    Part C of title VII (42 U.S.C. 293k et seq.) is amended by striking 
section 747 and inserting the following:

``SEC. 747. PRIMARY CARE TRAINING AND ENHANCEMENT.

    ``(a) Support and Development of Primary Care Training Programs.--
            ``(1) In general.--The Secretary may make grants to, or 
        enter into contracts with, an accredited public or nonprofit 
        private hospital, school of medicine or osteopathic medicine, 
        academically affiliated physician assistant training program, 
        or a public or private nonprofit entity which the Secretary has 
        determined is capable of carrying out such grant or contract--
                    ``(A) to plan, develop, operate, or participate in 
                an accredited professional training program, including 
                an accredited residency or internship program in the 
                field of family medicine, general internal medicine, or 
                general pediatrics for medical students, interns, 
                residents, or practicing physicians as defined by the 
                Secretary;
                    ``(B) to provide need-based financial assistance in 
                the form of traineeships and fellowships to medical 
                students, interns, residents, practicing physicians, or 
                other medical personnel, who are participants in any 
                such program, and who plan to specialize or work in the 
                practice of the fields defined in subparagraph (A);
                    ``(C) to plan, develop, and operate a program for 
                the training of physicians who plan to teach in family 
                medicine, general internal medicine, or general 
                pediatrics training programs;
                    ``(D) to plan, develop, and operate a program for 
                the training of physicians teaching in community-based 
                settings;
                    ``(E) to provide financial assistance in the form 
                of traineeships and fellowships to physicians who are 
                participants in any such programs and who plan to teach 
                or conduct research in a family medicine, general 
                internal medicine, or general pediatrics training 
                program;
                    ``(F) to plan, develop, and operate a physician 
                assistant education program, and for the training of 
                individuals who will teach in programs to provide such 
                training;
                    ``(G) to plan, develop, and operate a demonstration 
                program that provides training in new competencies, as 
                recommended by the Advisory Committee on Training in 
                Primary Care Medicine and Dentistry and the National 
                Health Care Workforce Commission established in section 
                411 of the Affordable Health Choices Act, which may 
                include--
                            ``(i) providing training to primary care 
                        physicians relevant to providing care through 
                        patient-centered medical homes (as defined by 
                        the Secretary for purposes of this section);
                            ``(ii) developing tools and curricula 
                        relevant to patient-centered medical homes; and
                            ``(iii) providing continuing education to 
                        primary care physicians relevant to patient-
                        centered medical homes; and
                    ``(H) to plan, develop, and operate joint degree 
                programs to provide interdisciplinary and 
                interprofessional graduate training in public health 
                and other health professions to provide training in 
                environmental health, infectious disease control, 
                disease prevention and health promotion, 
                epidemiological studies and injury control.
            ``(2) Duration of awards.--The period during which payments 
        are made to an entity from an award of a grant or contract 
        under this subsection shall be 5 years.
    ``(b) Capacity Building in Primary Care.--
            ``(1) In general.--The Secretary may make grants to or 
        enter into contracts with accredited schools of medicine or 
        osteopathic medicine to establish, maintain, or improve--
                    ``(A) academic units (which may be departments, 
                divisions, or other units) or programs that improve 
                clinical teaching and research in fields defined in 
                subsection (a)(1)(A); or
                    ``(B) programs that integrate academic 
                administrative units in fields defined in subsection 
                (a)(1)(A) to enhance interdisciplinary recruitment, 
                training, and faculty development.
            ``(2) Preference in making awards under this subsection.--
        In making awards of grants and contracts under paragraph (1), 
        the Secretary shall give preference to any qualified applicant 
        for such an award that agrees to expend the award for the 
        purpose of--
                    ``(A) establishing academic units or programs in 
                fields defined in subsection (a)(1)(A); or
                    ``(B) substantially expanding such units or 
                programs.
            ``(3) Priorities in making awards.--In awarding grants or 
        contracts under paragraph (1), the Secretary shall give 
        priority to qualified applicants that--
                    ``(A) proposes a collaborative project between 
                academic administrative units of primary care;
                    ``(B) proposes innovative approaches to clinical 
                teaching using models of primary care, such as the 
                patient centered medical home, team management of 
                chronic disease, and interprofessional integrated 
                models of health care that incorporate transitions in 
                health care settings and integration physical and 
                mental health provision;
                    ``(C) have a record of training the greatest 
                percentage of providers, or that have demonstrated 
                significant improvements in the percentage of providers 
                trained, who enter and remain in primary care practice;
                    ``(D) have a record of training individuals who are 
                from underrepresented minority groups or from a rural 
                or disadvantaged background;
                    ``(E) provide training in the care of vulnerable 
                populations such as children, older adults, homeless 
                individuals, victims of abuse or trauma, individuals 
                with mental health or substance-related disorders, 
                individuals with HIV/AIDS, and individuals with 
                disabilities;
                    ``(F) establish formal relationships and submit 
                joint applications with federally qualified health 
                centers, rural health clinics, area health education 
                centers, or clinics located in underserved areas or 
                that serve underserved populations;
                    ``(G) teach trainees the skills to provide 
                interprofessional, integrated care through 
                collaboration among health professionals;
                    ``(H) provide training in enhanced communication 
                with patients, evidence-based practice, chronic disease 
                management, preventive care, health information 
                technology, or other competencies as recommended by the 
                Advisory Committee on Training in Primary Care Medicine 
                and Dentistry and the National Health Care Workforce 
                Commission established in section 411 of the Affordable 
                Health Choices Act; or
                    ``(I) provide training in cultural competency and 
                health literacy.
            ``(4) Duration of awards.--The period during which payments 
        are made to an entity from an award of a grant or contract 
        under this subsection shall be 5 years.
    ``(c) Authorization of Appropriations.--
            ``(1) In general.--For purposes of carrying out this 
        section (other than subsection (b)(1)(B)), there are authorized 
        to be appropriated $125,000,000 for fiscal year 2010, and such 
        sums as may be necessary for each of fiscal years 2011 through 
        2014.
            ``(2) Training programs.--Fifteen percent of the amount 
        appropriated pursuant to paragraph (1) in each such fiscal year 
        shall be allocated to the physician assistant training programs 
        described in subsection (a)(1)(F), which prepare students for 
        practice in primary care.
            ``(3) Integrating academic administrative units.--For 
        purposes of carrying out subsection (b)(1)(B), there are 
        authorized to be appropriated $750,000 for each of fiscal years 
        2010 through 2014.''.

SEC. 432. TRAINING OPPORTUNITIES FOR DIRECT CARE WORKERS.

    Part C of title VII of the Public Health Service Act (42 U.S.C. 
293k et seq.) is amended by inserting after section 747, as amended by 
section 431, the following:

``SEC. 747A. TRAINING OPPORTUNITIES FOR DIRECT CARE WORKERS.

    ``(a) In General.--The Secretary shall award grants to eligible 
entities to enable such entities to provide new training opportunities 
for direct care workers who are employed in long-term care settings 
such as nursing homes (as defined in section 1908(e)(1) of the Social 
Security Act (42 U.S.C. 1396g(e)(1)), assisted living facilities and 
skilled nursing facilities, intermediate care facilities for 
individuals with mental retardation, home and community based settings, 
and any other setting the Secretary determines to be appropriate.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be an institution of higher education (as defined in 
        section 102 of the Higher Education Act of 1965 (20 U.S.C. 
        1002)) that--
                    ``(A) is accredited by a nationally recognized 
                accrediting agency or association listed under section 
                101(c) of the Higher Education Act of 1965 (20 U.S.C. 
                1001(c)); and
                    ``(B) has established a public-private educational 
                partnership with a nursing home or skilled nursing 
                facility, agency or entity providing home and community 
                based services to individuals with disabilities, or 
                other long-term care provider; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--An eligible entity shall use amounts awarded 
under a grant under this section to provide assistance to eligible 
individuals to offset the cost of tuition and required fees for 
enrollment in academic programs provided by such entity.
    ``(d) Eligible Individual.--
            ``(1) Eligibility.--To be eligible for assistance under 
        this section, an individual shall be enrolled in courses 
        provided by a grantee under this subsection and maintain 
        satisfactory academic progress in such courses.
            ``(2) Condition of assistance.--As a condition of receiving 
        assistance under this section, an individual shall agree that, 
        following completion of the assistance period, the individual 
        will work in the field of geriatrics, disability services, long 
        term services and supports, or chronic care management for a 
        minimum of 2 years under guidelines set by the Secretary.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $10,000,000 for the period of 
fiscal years 2011 through 2013.''.

SEC. 433. TRAINING IN GENERAL, PEDIATRIC, AND PUBLIC HEALTH DENTISTRY.

    Part C of Title VII of the Public Health Service Act (42 U.S.C. 
293k et seq.) is amended by--
            (1) redesignating section 748, as amended by section 413 of 
        this Act, as section 749; and
            (2) inserting after section 747A, as added by section 432, 
        the following:

``SEC. 748. TRAINING IN GENERAL, PEDIATRIC, AND PUBLIC HEALTH 
              DENTISTRY.

    ``(a) Support and Development of Dental Training Programs.--
            ``(1) In general.--The Secretary may make grants to, or 
        enter into contracts with, a school of dentistry, public or 
        nonprofit private hospital, or a public or private nonprofit 
        entity which the Secretary has determined is capable of 
        carrying out such grant or contract--
                    ``(A) to plan, develop, and operate, or participate 
                in, an approved professional training program in the 
                field of general dentistry, pediatric dentistry, or 
                public health dentistry for dental students, residents, 
                practicing dentists, dental hygienists, or other 
                approved primary care dental trainees, that emphasizes 
                training for general, pediatric, or public health 
                dentistry;
                    ``(B) to provide financial assistance to dental 
                students, residents, practicing dentists, and dental 
                hygiene students who are in need thereof, who are 
                participants in any such program, and who plan to work 
                in the practice of general, pediatric, public heath 
                dentistry, or dental hygiene;
                    ``(C) to plan, develop, and operate a program for 
                the training of oral health care providers who plan to 
                teach in general, pediatric, public health dentistry, 
                or dental hygiene;
                    ``(D) to provide financial assistance in the form 
                of traineeships and fellowships to dentists who plan to 
                teach or are teaching in general, pediatric, or public 
                health dentistry;
                    ``(E) to meet the costs of projects to establish, 
                maintain, or improve dental faculty development 
                programs in primary care (which may be departments, 
                divisions or other units);
                    ``(F) to meet the costs of projects to establish, 
                maintain, or improve predoctoral and postdoctoral 
                training in primary care programs;
                    ``(G) to create a loan repayment program for 
                faculty in dental programs; and
                    ``(H) to provide technical assistance to pediatric 
                training programs in developing and implementing 
                instruction regarding the oral health status, dental 
                care needs, and risk-based clinical disease management 
                of all pediatric populations with an emphasis on 
                underserved children.
            ``(2) Faculty loan repayment.--
                    ``(A) In general.--A grant or contract under 
                subsection (a)(1)(G) may be awarded to a program of 
                general, pediatric, or public health dentistry 
                described in such subsection to plan, develop, and 
                operate a loan repayment program under which--
                            ``(i) individuals agree to serve full-time 
                        as faculty members; and
                            ``(ii) the program of general, pediatric or 
                        public health dentistry agrees to pay the 
                        principal and interest on the outstanding 
                        student loans of the individuals.
                    ``(B) Manner of payments.--With respect to the 
                payments described in subparagraph (A)(ii), upon 
                completion by an individual of each of the first, 
                second, third, fourth, and fifth years of service, the 
                program shall pay an amount equal to 10, 15, 20, 25, 
                and 30 percent, respectively, of the individual's 
                student loan balance as calculated based on principal 
                and interest owed at the initiation of the agreement.
    ``(b) Eligible Entity.--For purposes of this subsection, entities 
eligible for such grants or contracts in general, pediatric, or public 
health dentistry shall include entities that have programs in dental or 
dental hygiene schools, or approved residency or advanced education 
programs in the practice of general, pediatric, or public health 
dentistry. Eligible entities may partner with schools of public health 
to permit the education of dental students, residents, and dental 
hygiene students for a master's year in public health at a school of 
public health.
    ``(c) Priorities in Making Awards.--With respect to training 
provided for under this section, the Secretary shall give priority in 
awarding grants or contracts to the following:
            ``(1) Qualified applicants that propose collaborative 
        projects between departments of primary care medicine and 
        departments of general, pediatric, or public health dentistry.
            ``(2) Qualified applicants that have a record of training 
        the greatest percentage of providers, or that have demonstrated 
        significant improvements in the percentage of providers, who 
        enter and remain in general, pediatric, or public health 
        dentistry.
            ``(3) Qualified applicants that have a record of training 
        individuals who are from a rural or disadvantaged background, 
        or from underrepresented minorities.
            ``(4) Qualified applicants that establish formal 
        relationships with Federally qualified health centers, rural 
        health centers, or accredited teaching facilities and that 
        conduct training of students, residents, fellows, or faculty at 
        the center or facility.
            ``(5) Qualified applicants that conduct teaching programs 
        targeting vulnerable populations such as older adults, homeless 
        individuals, victims of abuse or trauma, individuals with 
        mental health or substance-related disorders, individuals with 
        disabilities, and individuals with HIV/AIDS.
            ``(6) Qualified applicants that include educational 
        activities in cultural competency and health literacy.
            ``(7) Qualified applicants that provide instruction 
        regarding the oral health status, dental care needs, and risk-
        based clinical disease management of all populations, with an 
        emphasis on underserved children.
            ``(8) Qualified applicants that intend to establish a 
        special populations oral health care education center or 
        training program for the didactic and clinical education of 
        dentists, dental health professionals, and dental hygienists 
        who plan to teach oral health care for people with 
        developmental disabilities, cognitive impairment, complex 
        medical problems, significant physical limitations, and 
        vulnerable elderly.
    ``(d) Preference in Making Awards.--In making awards of grants or 
contracts under this section, the Secretary shall give preference to 
any qualified applicant that--
            ``(1) has a high rate for placing graduates in practice 
        settings having the principal focus of serving in underserved 
        areas or health disparity populations (including serving 
        patients eligible for Medicaid or the Children's Health 
        Insurance Program, or those with special health care needs); or
            ``(2) during the 2-year period before the fiscal year for 
        which such an award is sought, has achieved a significant 
        increase in the rate of placing graduates in such settings or 
        graduating practitioners who serve health disparity populations 
        in their practices.
    ``(e) Application.--An eligible entity desiring a grant under this 
section shall submit to the Secretary an application at such time, in 
such manner, and containing such information as the Secretary may 
require.
    ``(f) Duration of Award.--The period during which payments are made 
to an entity from an award of a grant or contract under subsection (a) 
shall be 5 years. The provision of such payments shall be subject to 
annual approval by the Secretary and subject to the availability of 
appropriations for the fiscal year involved to make the payments.
    ``(g) Authorizations of Appropriations.--For the purpose of 
carrying out subsections (a) and (b), there is authorized to be 
appropriated $30,000,000 for fiscal year 2010 and such sums as may be 
necessary for each of fiscal years 2011 through 2015.
    ``(h) Carryover Funds.--An entity that receives an award under this 
section may carry over funds from 1 fiscal year to another without 
obtaining approval from the Secretary. In no case may any funds be 
carried over pursuant to the preceding sentence for more than 3 
years.''.

SEC. 434. ALTERNATIVE DENTAL HEALTH CARE PROVIDERS DEMONSTRATION 
              PROJECT.

    Subpart X of part D of title III of the Public Health Service Act 
(42 U.S.C. 256f et seq.) is amended by adding at the end the following:

``SEC. 340H. DEMONSTRATION PROGRAM.

    ``(a) In General.--
            ``(1) Authorization.--The Secretary is authorized to award 
        grants to 15 eligible entities to enable such entities to 
        establish a demonstration program to establish training 
        programs to train, or to employ, alternative dental health care 
        providers in order to increase access to dental health care 
        services in rural and other underserved communities.
            ``(2) Definition.--The term `alternative dental health care 
        providers' includes community dental health coordinators, 
        advance practice dental hygienists, independent dental 
        hygienists, supervised dental hygienists, primary care 
        physicians, dental therapists, dental health aides, and any 
        other health professional that the Secretary determines 
        appropriate.
    ``(b) Timeframe.--The demonstration projects funded under this 
section shall begin not later than 2 years after the date of enactment 
of this section, and shall conclude not later than 7 years after such 
date of enactment.
    ``(c) Eligible Entities.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be--
                    ``(A) an institution of higher education, including 
                a community college;
                    ``(B) a public-private partnership;
                    ``(C) a federally qualified health center;
                    ``(D) an Indian Health Service facility or a tribe 
                or tribal organization (as such terms are defined in 
                section 4 of the Indian Self-Determination and 
                Education Assistance Act);
                    ``(E) a State or county public health clinic, a 
                health facility operated by an Indian tribe or tribal 
                organization, or urban Indian organization providing 
                dental services; or
                    ``(F) a public hospital or health system;
            ``(2) be within a program accredited by the Commission on 
        Dental Accreditation or within a dental education program in an 
        accredited institution; and
            ``(3) shall submit an application to the Secretary at such 
        time, in such manner, and containing such information as the 
        Secretary may require.
    ``(d) Administrative Provisions.--
            ``(1) Amount of grant.--Each grant under this section shall 
        be in an amount that is not less than $4,000,000 for the 5-year 
        period during which the demonstration project being conducted.
            ``(2) Disbursement of funds.--
                    ``(A) Preliminary disbursements.--Beginning 1 year 
                after the enactment of this section, the Secretary may 
                disperse to any entity receiving a grant under this 
                section not more than 20 percent of the total funding 
                awarded to such entity under such grant, for the 
                purpose of enabling the entity to plan the 
                demonstration project to be conducted under such grant.
                    ``(B) Subsequent disbursements.--The remaining 
                amount of grant funds not dispersed under subparagraph 
                (A) shall be dispersed such that not less than 15 
                percent of such remaining amount is dispersed each 
                subsequent year.
    ``(e) Compliance With State Requirements.--Each entity receiving a 
grant under this section shall certify that it is in compliance with 
all applicable State licensing requirements.
    ``(f) Evaluation.--
            ``(1) In general.--The Secretary shall contract with the 
        Director of the Institute of Medicine (referred to in this 
        subsection as the `Director') to conduct a study of the 
        demonstration programs conducted under this section that shall 
        provide analysis, based upon quantitative and qualitative data, 
        regarding access to dental health care in the United States.
            ``(2) Data collection.--
                    ``(A) Baseline data.--The Director shall gather 
                data from each demonstration project not later than 24 
                months after the commencement of the project, which 
                shall serve as baseline data for the study.
                    ``(B) Comparison data.--The Director shall begin 
                collecting data from each demonstration project 1 year 
                after such project concludes, and shall conclude such 
                data collection not later than 18 months after the 
                conclusion of the project.
    ``(g) Clarification Regarding Dental Health Aide Program.--Nothing 
in this section shall prohibit a dental health aide training program 
approved by the Indian Health Service from being eligible for a grant 
under this section.
    ``(h) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.

SEC. 435. GERIATRIC EDUCATION AND TRAINING; CAREER AWARDS; 
              COMPREHENSIVE GERIATRIC EDUCATION.

    (a) Workforce Development; Career Awards.--Section 753 of the 
Public Health Service Act (42 U.S.C. 294c) is amended by adding at the 
end the following:
    ``(d) Geriatric Workforce Development.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this subsection to entities that operate a 
        geriatric education center pursuant to subsection (a)(1).
            ``(2) Application.--To be eligible for an award under 
        paragraph (1), an entity described in such paragraph shall 
        submit to the Secretary an application at such time, in such 
        manner, and containing such information as the Secretary may 
        require.
            ``(3) Use of funds.--Amounts awarded under a grant or 
        contract under paragraph (1) shall be used to--
                    ``(A) carry out the fellowship program described in 
                paragraph (4); and
                    ``(B) carry out 1 of the 2 activities described in 
                paragraph (5).
            ``(4) Fellowship program.--
                    ``(A) In general.--Pursuant to paragraph (3), a 
                geriatric education center that receives an award under 
                this subsection shall use such funds to offer short-
                term intensive courses (referred to in this subsection 
                as a `fellowship') that focus on geriatrics, chronic 
                care management, and long-term care that provide 
                supplemental training for faculty members in medical 
                schools and other health professions schools with 
                programs in psychology, pharmacy, nursing, social work, 
                dentistry, public health, allied health, or other 
                health disciplines, as approved by the Secretary. Such 
                a fellowship shall be open to current faculty, and 
                appropriately credentialed volunteer faculty and 
                practitioners, who do not have formal training in 
                geriatrics, to upgrade their knowledge and clinical 
                skills for the care of older adults and adults with 
                functional limitations and to enhance their 
                interdisciplinary teaching skills.
                    ``(B) Location.--A fellowship shall be offered 
                either at the geriatric education center that is 
                sponsoring the course, in collaboration with other 
                geriatric education centers, or at medical schools, 
                schools of dentistry, schools of nursing, schools of 
                pharmacy, schools of social work, graduate programs in 
                psychology, or allied health and other health 
                professions schools approved by the Secretary with 
                which the geriatric education centers are affiliated.
                    ``(C) CME credit.--Participation in a fellowship 
                under this paragraph shall be accepted with respect to 
                complying with continuing health profession education 
                requirements. As a condition of such acceptance, the 
                recipient shall agree to subsequently provide a minimum 
                of 18 hours of voluntary instructional support through 
                a geriatric education center that is providing clinical 
                training to students or trainees in long-term care 
                settings.
            ``(5) Additional required activities described.--Pursuant 
        to paragraph (3), a geriatric education center that receives an 
        award under this subsection shall use such funds to carry out 1 
        of the following 2 activities.
                    ``(A) Family caregiver and direct care provider 
                training.--A geriatric education center that receives 
                an award under this subsection shall offer at least 2 
                courses each year, at no charge or nominal cost, to 
                family caregivers and direct care providers that are 
                designed to provide practical training for supporting 
                frail elders and individuals with disabilities. The 
                Secretary shall require such Centers to work with 
                appropriate community partners to develop training 
                program content and to publicize the availability of 
                training courses in their service areas. All family 
                caregiver and direct care provider training programs 
                shall include instruction on the management of 
                psychological and behavioral aspects of dementia, 
                communication techniques for working with individuals 
                who have dementia, and the appropriate, safe, and 
                effective use of medications for older adults.
                    ``(B) Incorporation of best practices.--A geriatric 
                education center that receives an award under this 
                subsection shall develop and include material on 
                depression and other mental disorders common among 
                older adults, medication safety issues for older 
                adults, and management of the psychological and 
                behavioral aspects of dementia and communication 
                techniques with individuals who have dementia in all 
                training courses, where appropriate.
            ``(6) Targets.--A geriatric education center that receives 
        an award under this subsection shall meet targets approved by 
        the Secretary for providing geriatric training to a certain 
        number of faculty or practitioners during the term of the 
        award, as well as other parameters established by the 
        Secretary, including guidelines for the content of the 
        fellowships.
            ``(7) Amount of award.--An award under this subsection 
        shall be in an amount of $150,000. Not more than 24 geriatric 
        education centers may receive an award under this subsection.
            ``(8) Maintenance of effort.--A geriatric education center 
        that receives an award under this subsection shall provide 
        assurances to the Secretary that funds provided to the 
        geriatric education center under this subsection will be used 
        only to supplement, not to supplant, the amount of Federal, 
        State, and local funds otherwise expended by the geriatric 
        education center.
            ``(9) Authorization of appropriations.--In addition to any 
        other funding available to carry out this section, there is 
        authorized to be appropriated to carry out this subsection, 
        $10,800,000 for the period of fiscal year 2011 through 2014.
    ``(e) Geriatric Career Incentive Awards.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this section to individuals described in 
        paragraph (2) to foster greater interest among a variety of 
        health professionals in entering the field of geriatrics, long-
        term care, and chronic care management.
            ``(2) Eligible individuals.--To be eligible to received an 
        award under paragraph (1), an individual shall--
                    ``(A) be an advanced practice nurse, a clinical 
                social worker, a pharmacist, or student of psychology 
                who is pursuing a doctorate or other advanced degree in 
                geriatrics or related fields in an accredited health 
                professions school; and
                    ``(B) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require.
            ``(3) Condition of award.--As a condition of receiving an 
        award under this subsection, an individual shall agree that, 
        following completion of the award period, the individual will 
        teach or practice in the field of geriatrics, long-term care, 
        or chronic care management for a minimum of 5 years under 
        guidelines set by the Secretary.
            ``(4) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, $10,000,000 
        for the period of fiscal years 2011 through 2013.''.
    (b) Expansion of Eligibility for Geriatric Academic Career Awards; 
Payment to Institution.--Section 753(c) of the Public Health Service 
Act 294(c)) is amended--
            (1) by redesignating paragraphs (4) and (5) as paragraphs 
        (5) and (6), respectively;
            (2) by striking paragraph (2) through paragraph (3) and 
        inserting the following:
            ``(2) Eligible individuals.--To be eligible to receive an 
        Award under paragraph (1), an individual shall--
                    ``(A) be board certified or board eligible in 
                internal medicine, family practice, psychiatry, or 
                licensed dentistry, or have completed any required 
                training in a discipline and employed in an accredited 
                health professions school that is approved by the 
                Secretary;
                    ``(B) have completed an approved fellowship program 
                in geriatrics; and
                    ``(C) have a junior (non-tenured) faculty 
                appointment at an accredited (as determined by the 
                Secretary) school of medicine, osteopathic medicine, 
                nursing, social work, psychology, dentistry, pharmacy, 
                or other allied health disciplines in an accredited 
                health professions school that is approved by the 
                Secretary.
            ``(3) Limitations.--No Award under paragraph (1) may be 
        made to an eligible individual unless the individual--
                    ``(A) has submitted to the Secretary an 
                application, at such time, in such manner, and 
                containing such information as the Secretary may 
                require, and the Secretary has approved such 
                application;
                    ``(B) provides, in such form and manner as the 
                Secretary may require, assurances that the individual 
                will meet the service requirement described in 
                paragraph (6); and
                    ``(C) provides, in such form and manner as the 
                Secretary may require, assurances that the individual 
                has a full-time faculty appointment in a health 
                professions institution and documented commitment from 
                such institution to spend 75 percent of the total time 
                of such individual on teaching and developing skills in 
                interdisciplinary education in geriatrics.
            ``(4) Maintenance of effort.--An eligible individual that 
        receives an Award under paragraph (1) shall provide assurances 
        to the Secretary that funds provided to the eligible individual 
        under this subsection will be used only to supplement, not to 
        supplant, the amount of Federal, State, and local funds 
        otherwise expended by the eligible individual.''; and
            (3) in paragraph (5), as so designated--
                    (A) in subparagraph (A)--
                            (i) by inserting ``for individuals who are 
                        physicians'' after ``this section''; and
                            (ii) by inserting after the period at the 
                        end the following: ``The Secretary shall 
                        determine the amount of an Award under this 
                        section for individuals who are not 
                        physicians.''; and
                    (B) by adding at the end the following:
                    ``(C) Payment to institution.--The Secretary shall 
                transfer funds awarded to an individual under this 
                section to the institution where such individual will 
                carry out the award, in order to facilitate financial 
                management of the reward pursuant to guidelines of the 
                Health Resources and Services Administration.''.
    (c) Comprehensive Geriatric Education.--Section 855 of the Public 
Health Service Act (42 U.S.C. 298) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (3), by striking ``or'' at the 
                end;
                    (B) in paragraph (4), by striking the period and 
                inserting ``; or''; and
                    (C) by adding at the end the following:
            ``(5) establish traineeships for individuals who are 
        preparing for advanced education nursing degrees in geriatric 
        nursing, long-term care, gero-psychiatric nursing or other 
        nursing areas that specialize in the care of the elderly 
        population.''; and
            (2) in subsection (e), by striking ``2003 through 2007'' 
        and inserting ``2010 through 2014''.

SEC. 436. MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS.

    (a) In General.--Part D of title VII (42 U.S.C. 294 et seq.) is 
amended by--
            (1) striking section 757;
            (2) redesignating section 756 (as amended by section 413) 
        as section 757; and
            (3) inserting after section 755 the following:

``SEC. 756. MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS.

    ``(a) Grants Authorized.--The Secretary may award grants to 
eligible institutions of higher education to support the recruitment of 
students for, and education and clinical experience of the students 
in--
            ``(1) baccalaureate, master's, and doctoral degree programs 
        of social work, as well as the development of faculty in social 
        work;
            ``(2) accredited master's, doctoral, internship, and post-
        doctoral residency programs of psychology for the development 
        and implementation of interdisciplinary training of psychology 
        graduate students for providing behavioral and mental health 
        services, including substance abuse prevention and treatment 
        services;
            ``(3) accredited institutions of higher education or 
        accredited professional training programs that are establishing 
        or expanding internships or other field placement programs in 
        child and adolescent mental health in psychiatry, psychology, 
        school psychology, behavioral pediatrics, psychiatric nursing, 
        social work, school social work, substance abuse prevention and 
        treatment, marriage and family therapy, school counseling, or 
        professional counseling; and
            ``(4) State-licensed mental health nonprofit and for-profit 
        organizations to enable such organizations to pay for programs 
        for preservice or in-service training of paraprofessional child 
        and adolescent mental health workers.
    ``(b) Eligibility Requirements.--To be eligible for a grant under 
this section, an institution shall demonstrate--
            ``(1) participation in the institutions' programs of 
        individuals and groups from different racial, ethnic, cultural, 
        geographic, religious, linguistic, and class backgrounds, and 
        different genders and sexual orientations;
            ``(2) knowledge and understanding of the concerns of the 
        individuals and groups described in subsection (a);
            ``(3) any internship or other field placement program 
        assisted under the grant will prioritize cultural and 
        linguistic competency;
            ``(4) the institution will provide to the Secretary such 
        data, assurances, and information as the Secretary may require; 
        and
            ``(5) with respect to any violation of the agreement 
        between the Secretary and the institution, the institution will 
        pay such liquidated damages as prescribed by the Secretary by 
        regulation.
    ``(c) Institutional Requirement.--For grants authorized under 
subsection (a)(1), at least 4 of the grant recipients shall be 
historically black colleges or universities or other minority-serving 
institutions.
    ``(d) Priority.--
            ``(1) In selecting the grant recipients in social work 
        under subsection (a)(1), the Secretary shall give priority to 
        applicants that--
                    ``(A) are accredited by the Council on Social Work 
                Education;
                    ``(B) have a graduation rate of not less than 80 
                percent for social work students; and
                    ``(C) exhibit an ability to recruit social workers 
                from and place social workers in areas with a high need 
                and high demand population.
            ``(2) In selecting the grant recipients in graduate 
        psychology under subsection (a)(2), the Secretary shall give 
        priority to institutions in which training focuses on the needs 
        of vulnerable groups such as older adults and children, 
        individuals with mental health or substance-related disorders, 
        victims of abuse or trauma and of combat stress disorders such 
        as posttraumatic stress disorder and traumatic brain injuries, 
        homeless individuals, chronically ill persons, and their 
        families.
            ``(3) In selecting the grant recipients in professional 
        training programs in child and adolescent mental health under 
        subsection (a)(3), the Secretary shall give priority to 
        applicants that--
                    ``(A) have demonstrated the ability to collect data 
                on the number of students trained in child and 
                adolescent mental health and the populations served by 
                such students after graduation;
                    ``(B) have demonstrated familiarity with evidence-
                based methods in child and adolescent mental health 
                services, including substance abuse prevention and 
                treatment services;
                    ``(C) have programs designed to increase the number 
                of paraprofessionals serving high-priority populations 
                and to applicants who come from high-priority 
                communities and plan to serve in Health Professional 
                Shortage Areas, Medically Underserved Areas, or 
                Medically Underserved Populations; and
                    ``(D) offer curriculum taught collaboratively with 
                a family on the consumer and family lived experience or 
                the importance of family-professional partnership.
            ``(4) In selecting the grant recipients to offer preservice 
        or in-service training of paraprofessional child and adolescent 
        mental health workers under subsection (a)(4), the Secretary 
        shall give priority to applicants that--
                    ``(A) have demonstrated the ability to collect data 
                on the number of paraprofessional child and adolescent 
                mental health workers trained by the applicant and the 
                populations served by these workers after the 
                completion of the training;
                    ``(B) have demonstrated familiarity with evidence-
                based methods in child and adolescent mental health 
                services;
                    ``(C) have programs designed to increase the number 
                of professionals serving high-priority populations, or 
                who come from high-priority communities and plan to 
                serve medically underserved populations or in health 
                professional shortage areas or medically underserved 
                areas;
                    ``(D) offer curriculum taught collaboratively with 
                a family on the consumer and family lived experience or 
                the importance of family-paraprofessional partnership; 
                and
                    ``(E) provide services through a community mental 
                health program described in section 1913(b)(1).
    ``(e) Authorization of Appropriation.--For the fiscal years 2010 
through 2013, there is authorized to be appropriated to carry out this 
section--
            ``(1) $8,000,000 for training in social work in subsection 
        (a)(1);
            ``(2) $12,000,000 for training in graduate psychology in 
        subsection (a)(2), of which not less than $10,000,000 shall be 
        allocated for doctoral, postdoctoral, and internship level 
        training;
            ``(3) $10,000,000 for training in professional child and 
        adolescent mental health in subsection (a)(3); and
            ``(4) $5,000,000 for training in paraprofessional child and 
        adolescent work in subsection (a)(4).''.
    (b) Conforming Amendments.--Section 757(b)(2) of the Public Health 
Service Act, as redesignated by subsection (a), is amended by striking 
``sections 751(a)(1)(A), 751(a)(1)(B), 753(b), 754(3)(A), and 755(b)'' 
and inserting ``sections 751(b), 753(b), and 755(b)''.

SEC. 437. CULTURAL COMPETENCY, PREVENTION AND PUBLIC HEALTH AND 
              INDIVIDUALS WITH DISABILITIES TRAINING.

    Part B of title VII of the Public Health Service Act (42 U.S.C. 293 
et seq.) is amended by adding at the end the following:

``SEC. 742. CULTURAL COMPETENCY, PREVENTION AND PUBLIC HEALTH AND 
              INDIVIDUALS WITH DISABILITIES TRAINING.

    ``(a) In General.--The Secretary shall support the development, 
evaluation, and dissemination of model curricula for cultural 
competency, prevention, and public health proficiency and aptitude for 
working with individuals with disabilities training for use in health 
professions schools and continuing education programs, and for other 
purposes determined appropriate by the Secretary.
    ``(b) Curricula.--
            ``(1) Collaboration.--In carrying out subsection (a), the 
        Secretary shall collaborate with health professional societies, 
        licensing and accreditation entities, health professions 
        schools, and experts in minority health and cultural 
        competency, prevention and public health and disability groups, 
        community-based organizations, and other organizations as 
        determined appropriate by the Secretary.
            ``(2) Focus.--Curricula developed under this section shall 
        include a focus on cultural competency measures, prevention and 
        public health competency measures, and working with individuals 
        with disabilities competency measures. In addition, cultural 
        competency, prevention and public health proficiency, and 
        working with individuals with disabilities aptitude self-
        assessment methodology for health providers, systems, and 
        institutions.
    ``(c) Dissemination.--
            ``(1) In general.--Model curricula developed under this 
        section shall be disseminated through the Internet 
        Clearinghouse under section 270 and such other means as 
        determined appropriate by the Secretary.
            ``(2) Evaluation.--The Secretary shall evaluate the 
        adoption and the implementation of cultural competency, 
        prevention and public health, and working with individuals with 
        a disability training curricula, and the facilitate inclusion 
        of these competency measures in quality measurement systems as 
        appropriate.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as necessary for each 
of the fiscal years 2010 through 2015.''.

SEC. 438. ADVANCED NURSING EDUCATION GRANTS.

    Section 811 of the Public Health Service Act (42 U.S.C. 296j) is 
amended--
            (1) in subsection (c)--
                    (A) in the subsection heading, by striking ``and 
                Nurse Midwifery Programs''; and
                    (B) by striking ``and nurse midwifery'';
            (2) in subsection (f)--
                    (A) by striking paragraph (2); and
                    (B) by redesignating paragraph (3) as paragraph 
                (2); and
            (3) by redesignating subsections (d), (e), and (f) as 
        subsections (e), (f), and (g), respectively; and
            (4) by inserting after subsection (c), the following:
    ``(d) Authorized Nurse-midwifery Programs.--Midwifery programs that 
are eligible for support under this section are educational programs 
that--
            ``(1) have as their objective the education of midwives, 
        who will upon completion of their studies in such programs, be 
        qualified to effectively provide primary health care services 
        to women at locations where women might require health care 
        services, including acute care facilities, ambulatory care 
        facilities, birth centers, personal residences, and other 
        settings as authorized by State or Federal law; and
            ``(2) are accredited by the American College of Nurse-
        Midwives Accreditation Commission for Midwifery Education.''.

SEC. 439. NURSE EDUCATION, PRACTICE, AND RETENTION GRANTS.

    (a) In General.--Section 831 of the Public Health Service Act (42 
U.S.C. 296p) is amended--
            (1) in the section heading, by striking ``retention'' and 
        inserting ``quality'';
            (2) in subsection (a)--
                    (A) in paragraph (1), by adding ``or'' after the 
                semicolon;
                    (B) by striking paragraph (2); and
                    (C) by redesignating paragraph (3) as paragraph 
                (2);
            (3) in subsection (b)(3), by striking ``managed care, 
        quality improvement'' and inserting ``coordinated care'';
            (4) in subsection (g), by inserting ``, as defined in 
        section 801(2),'' after ``school of nursing''; and
            (5) in subsection (h), by striking ``2003 through 2007'' 
        and inserting ``2010 through 2014''.
    (b) Nurse Retention Grants.--Title VIII of the Public Health 
Service Act is amended by inserting after section 831 (42 U.S.C. 296b) 
the following:

``SEC. 831A. NURSE RETENTION GRANTS.

    ``(a) Retention Priority Areas.--The Secretary may award grants to, 
and enter into contracts with, eligible entities to enhance the nursing 
workforce by initiating and maintaining nurse retention programs 
pursuant to subsection (b) or (c).
    ``(b) Grants for Career Ladder Program.--The Secretary may award 
grants to, and enter into contracts with, eligible entities for 
programs--
            ``(1) to promote career advancement for individuals 
        including licensed practical nurses, licensed vocational 
        nurses, certified nurse assistants, home health aides, diploma 
        degree or associate degree nurses, to become baccalaureate 
        prepared registered nurses or advanced education nurses in 
        order to meet the needs of the registered nurse workforce;
            ``(2) developing and implementing internships and residency 
        programs in collaboration with an accredited school of nursing, 
        as defined by section 801(2), to encourage mentoring and the 
        development of specialties; or
            ``(3) to assist individuals in obtaining education and 
        training required to enter the nursing profession and advance 
        within such profession, such as by providing career counseling 
        and mentoring.
    ``(c) Enhancing Patient Care Delivery Systems.--
            ``(1) Grants.--The Secretary may award grants to eligible 
        entities to improve the retention of nurses and enhance patient 
        care that is directly related to nursing activities by 
        enhancing collaboration and communication among nurses and 
        other health care professionals, and by promoting nurse 
        involvement in the organizational and clinical decision-making 
        processes of a health care facility.
            ``(2) Priority.--In making awards of grants under this 
        subsection, the Secretary shall give preference to applicants 
        that have not previously received an award under this 
        subsection (or section 831(c) as such section existed on the 
        day before the date of enactment of this section).
            ``(3) Continuation of an award.--The Secretary shall make 
        continuation of any award under this subsection beyond the 
        second year of such award contingent on the recipient of such 
        award having demonstrated to the Secretary measurable and 
        substantive improvement in nurse retention or patient care.
    ``(d) Other Priority Areas.--The Secretary may award grants to, or 
enter into contracts with, eligible entities to address other areas 
that are of high priority to nurse retention, as determined by the 
Secretary.
    ``(e) Report.--The Secretary shall submit to the Congress before 
the end of each fiscal year a report on the grants awarded and the 
contracts entered into under this section. Each such report shall 
identify the overall number of such grants and contracts and provide an 
explanation of why each such grant or contract will meet the priority 
need of the nursing workforce.
    ``(f) Eligible Entity.--For purposes of this section, the term 
`eligible entity' includes an accredited school of nursing, as defined 
by section 801(2), a health care facility, or a partnership of such a 
school and facility.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2012.''.

SEC. 440. LOAN REPAYMENT AND SCHOLARSHIP PROGRAM.

    (a) Loan Repayments and Scholarships.--Section 846(a)(3) of the 
Public Health Service Act (42 U.S.C. 297n(a)(3)) is amended by 
inserting before the semicolon the following: ``, or in a accredited 
school of nursing, as defined by section 801(2), as nurse faculty''.
    (b) Technical and Conforming Amendments.--Title VIII (42 U.S.C. 296 
et seq.) is amended--
            (1) by redesignating section 810 (relating to prohibition 
        against discrimination by schools on the basis of sex) as 
        section 809 and moving such section so that it follows section 
        808;
            (2) in sections 835, 836, 838, 840, and 842, by striking 
        the term ``this subpart'' each place it appears and inserting 
        ``this part'';
            (3) in section 836(h), by striking the last sentence;
            (4) in section 836, by redesignating subsection (l) as 
        subsection (k);
            (5) in section 839, by striking ``839'' and all that 
        follows through ``(a)'' and inserting ``839. (a)'';
            (6) in section 835(b), by striking ``841'' each place it 
        appears and inserting ``871'';
            (7) by redesignating section 841 as section 871, moving 
        part F to the end of the title, and redesignating such part as 
        part I;
            (8) in part G--
                    (A) by redesignating section 845 as section 851; 
                and
                    (B) by redesignating part G as part F;
            (9) in part H--
                    (A) by redesignating sections 851 and 852 as 
                sections 861 and 862, respectively; and
                    (B) by redesignating part H as part G; and
            (10) in part I--
                    (A) by redesignating section 855, as amended by 
                section 435, as section 865; and
                    (B) by redesignating part I as part H.

SEC. 441. NURSE FACULTY LOAN PROGRAM.

    (a) In General.--Section 846A of the Public Health Service Act (42 
U.S.C. 297n-1) is amended--
            (1) in subsection (a)--
                    (A) in the subsection heading, by striking 
                ``Establishment'' and inserting ``School of Nursing 
                Student Loan Fund''; and
                    (B) by inserting ``accredited'' after ``agreement 
                with any'';
            (2) in subsection (c)--
                    (A) in paragraph (2), by striking ``$30,000'' and 
                all that follows through the semicolon and inserting 
                ``$35,500, during fiscal years 2010 and 2011 fiscal 
                years (after fiscal year 2011, such amounts shall be 
                adjusted to provide for a cost-of-attendance increase 
                for the yearly loan rate and the aggregate loan;''; and
                    (B) in paragraph (3)(A), by inserting ``an 
                accredited'' after ``faculty member in'';
            (3) in subsection (e), by striking ``a school'' and 
        inserting ``an accredited school''; and
            (4) in subsection (f), by striking ``2003 through 2007'' 
        and inserting ``2010 through 2014''.
    (b) Eligible Individual Student Loan Repayment.--Title VIII of the 
Public Health Service Act is amended by inserting after section 846A 
(42 U.S.C. 297n-1) the following:

``SEC. 847. ELIGIBLE INDIVIDUAL STUDENT LOAN REPAYMENT.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, may enter into an 
agreement with eligible individuals for the repayment of education 
loans, in accordance with this section, to increase the number of 
qualified nursing faculty.
    ``(b) Agreements.--Each agreement entered into under this 
subsection shall require that the eligible individual shall serve as a 
full-time member of the faculty of an accredited school of nursing, for 
a total period, in the aggregate, of at least 4 years during the 6-year 
period beginning on the later of--
            ``(1) the date on which the individual receives a master's 
        or doctorate nursing degree from an accredited school of 
        nursing; or
            ``(2) the date on which the individual enters into an 
        agreement under this subsection.
    ``(c) Agreement Provisions.--Agreements entered into pursuant to 
subsection (b) shall be entered into on such terms and conditions as 
the Secretary may determine, except that--
            ``(1) not more than 10 months after the date on which the 
        6-year period described under subsection (b) begins, but in no 
        case before the individual starts as a full-time member of the 
        faculty of an accredited school of nursing the Secretary shall 
        begin making payments, for and on behalf of that individual, on 
        the outstanding principal of, and interest on, any loan of that 
        individual obtained to pay for such degree;
            ``(2) for an individual who has completed a master's in 
        nursing or equivalent degree in nursing--
                    ``(A) payments may not exceed $10,000 per calendar 
                year; and
                    ``(B) total payments may not exceed $40,000 during 
                the 2010 and 2011 fiscal years (after fiscal year 2011, 
                such amounts shall be adjusted to provide for a cost-
                of-attendance increase for the yearly loan rate and the 
                aggregate loan); and
            ``(3) for an individual who has completed a doctorate or 
        equivalent degree in nursing--
                    ``(A) payments may not exceed $20,000 per calendar 
                year; and
                    ``(B) total payments may not exceed $80,000 during 
                the 2010 and 2011 fiscal years (adjusted for subsequent 
                fiscal years as provided for in the same manner as in 
                paragraph (2)(B)).
    ``(d) Breach of Agreement.--
            ``(1) In general.--In the case of any agreement made under 
        subsection (b), the individual is liable to the Federal 
        Government for the total amount paid by the Secretary under 
        such agreement, and for interest on such amount at the maximum 
        legal prevailing rate, if the individual fails to meet the 
        agreement terms required under such subsection.
            ``(2) Waiver or suspension of liability.--In the case of an 
        individual making an agreement for purposes of paragraph (1), 
        the Secretary shall provide for the waiver or suspension of 
        liability under such paragraph if compliance by the individual 
        with the agreement involved is impossible or would involve 
        extreme hardship to the individual or if enforcement of the 
        agreement with respect to the individual would be 
        unconscionable.
            ``(3) Date certain for recovery.--Subject to paragraph (2), 
        any amount that the Federal Government is entitled to recover 
        under paragraph (1) shall be paid to the United States not 
        later than the expiration of the 3-year period beginning on the 
        date the United States becomes so entitled.
            ``(4) Availability.--Amounts recovered under paragraph (1) 
        shall be available to the Secretary for making loan repayments 
        under this section and shall remain available for such purpose 
        until expended.
    ``(e) Eligible Individual Defined.--For purposes of this section, 
the term `eligible individual' means an individual who--
            ``(1) is a United States citizen, national, or lawful 
        permanent resident;
            ``(2) holds an unencumbered license as a registered nurse; 
        and
            ``(3) has either already completed a master's or doctorate 
        nursing program at an accredited school of nursing or is 
        currently enrolled on a full-time or part-time basis in such a 
        program.
    ``(f) Priority.--For the purposes of this section and section 846A, 
funding priority will be awarded to School of Nursing Student Loans 
that support doctoral nursing students or Individual Student Loan 
Repayment that support doctoral nursing students.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2014.''.

SEC. 442. AUTHORIZATION OF APPROPRIATIONS FOR PARTS B THROUGH D OF 
              TITLE VIII.

    Section 871 of the Public Health Service Act, as redesignated and 
moved by section 440, is amended to read as follows:

``SEC. 871. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purpose of carrying out parts B, C, and D (subject to 
section 851(g)), there are authorized to be appropriated $338,000,000 
for fiscal year 2010, and such sums as may be necessary for each of the 
fiscal years 2011 through 2016.''.

SEC. 443. GRANTS TO PROMOTE THE COMMUNITY HEALTH WORKFORCE.

    (a) In General.--Part P of title III of the Public Health Service 
Act (42 U.S.C. 280g et seq.), as amended by subsection (b), is amended 
by adding at the end the following:

``SEC. 399U. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS AND OUTCOMES.

    ``(a) Grants Authorized.--The Director of the Centers for Disease 
Control and Prevention, in collaboration with the Secretary, shall 
award grants to eligible entities to promote positive health behaviors 
and outcomes for populations in medically underserved communities 
through the use of community health workers.
    ``(b) Use of Funds.--Grants awarded under subsection (a) shall be 
used to support community health workers--
            ``(1) to educate, guide, and provide outreach in a 
        community setting regarding health problems prevalent in 
        medically underserved communities, particularly racial and 
        ethnic minority populations;
            ``(2) to educate, guide, and provide experiential learning 
        opportunities that target behavioral risk factors;
            ``(3) to educate and provide guidance regarding effective 
        strategies to promote positive health behaviors within the 
        family;
            ``(4) 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 XVIII of such Act and Medicaid under title 
        XIX of such Act;
            ``(5) to educate and refer underserved populations to 
        appropriate healthcare agencies and community-based programs 
        and organizations in order to increase access to quality 
        healthcare services and to eliminate duplicative care; or
            ``(6) to educate, guide, and provide home visitation 
        services regarding maternal health and prenatal care.
    ``(c) Application.--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 
information as the Secretary may require.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to applicants that--
            ``(1) propose to target geographic areas--
                    ``(A) with a high percentage of residents who are 
                eligible for health insurance but are uninsured or 
                underinsured;
                    ``(B) with a high percentage of residents who 
                suffer from chronic diseases; or
                    ``(C) with a high infant mortality rate;
            ``(2) have experience in providing health or health-related 
        social services to individuals who are underserved with respect 
        to such services; and
            ``(3) have documented community activity and experience 
        with community health workers.
    ``(e) Collaboration With Academic Institutions and the One-stop 
Delivery System.--The Secretary shall encourage community health worker 
programs receiving funds under this section to collaborate with 
academic institutions and one-stop delivery systems under section 
134(c) of the Workforce Investment Act of 1998. Nothing in this section 
shall be construed to require such collaboration.
    ``(f) Evidence-based Interventions.--The Secretary shall encourage 
community health worker programs receiving funding under this section 
to implement a process or an outcome-based payment system that rewards 
community health workers for connecting underserved populations with 
the most appropriate services at the most appropriate time. Nothing in 
this section shall be construed to require such a payment.
    ``(g) Quality Assurance and Cost Effectiveness.--The Secretary 
shall establish guidelines for assuring the quality of the training and 
supervision of community health workers under the programs funded under 
this section and for assuring the cost-effectiveness of such programs.
    ``(h) Monitoring.--The Secretary shall monitor community health 
worker programs identified in approved applications under this section 
and shall determine whether such programs are in compliance with the 
guidelines established under subsection (g).
    ``(i) Technical Assistance.--The Secretary may provide technical 
assistance to community health worker programs identified in approved 
applications under this section with respect to planning, developing, 
and operating programs under the grant.
    ``(j) Authorization of Appropriations.--There are authorized to be 
appropriated, such sums as may be necessary to carry out this section 
for each of fiscal years 2010 through 2014.
    ``(k) Definitions.--In this section:
            ``(1) Community health worker.--The term `community health 
        worker', as defined by the Department of Labor as Standard 
        Occupational Classification [21-1094] means an individual who 
        promotes health or nutrition within the community in which the 
        individual resides--
                    ``(A) by serving as a liaison between communities 
                and healthcare agencies;
                    ``(B) by providing guidance and social assistance 
                to community residents;
                    ``(C) by enhancing community residents' ability to 
                effectively communicate with healthcare providers;
                    ``(D) by providing culturally and linguistically 
                appropriate health or nutrition education;
                    ``(E) by advocating for individual and community 
                health; and
                    ``(F) by providing referral and follow-up services 
                or otherwise coordinating care.
            ``(2) Community setting.--The term `community setting' 
        means a home or a community organization located in the 
        neighborhood in which a participant in the program under this 
        section resides.
            ``(3) Eligible entity.--The term `eligible entity' means a 
        public or nonprofit private entity (including a State or public 
        subdivision of a State, a public health department, a free 
        health clinic, a hospital, or a Federally-qualified health 
        center (as defined in section 1861(aa) of the Social Security 
        Act)), or a consortium of any such entities.
            ``(4) Medically underserved community.--The term `medically 
        underserved community' means a community identified by a 
        State--
                    ``(A) that has a substantial number of individuals 
                who are members of a medically underserved 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.''.
    (b) Technical Amendments.--
            (1) Section 399R of the Public Health Service Act (as added 
        by section 2 of the ALS Registry Act (Public Law 110-373; 122 
        Stat. 4047)) is redesignated as section 399S.
            (2) Section 399R of such Act (as added by section 3 of the 
        Prenatally and Postnatally Diagnosed Conditions Awareness Act 
        (Public Law 110-374; 122 Stat. 4051)) is redesignated as 
        section 399T.

SEC. 444. YOUTH PUBLIC HEALTH PROGRAM.

    Section 751(b)(4)(A) of the Public Health Service Act, as amended 
by section 453, is further amended by adding at the end the following:
                            ``(vii) Establish a youth public health 
                        program to expose and recruit high school 
                        students into health careers, with a focus on 
                        careers in public health.''.

SEC. 445. FELLOWSHIP TRAINING IN PUBLIC HEALTH.

    Part E of title VII of the Public Health Service Act (42 U.S.C. 
294n et seq.), as amended by section 426, is further amended by adding 
at the end the following:

``SEC. 778. FELLOWSHIP TRAINING IN APPLIED PUBLIC HEALTH EPIDEMIOLOGY, 
              PUBLIC HEALTH LABORATORY SCIENCE, PUBLIC HEALTH 
              INFORMATICS, AND EXPANSION OF THE EPIDEMIC INTELLIGENCE 
              SERVICE.

    ``(a) In General.--The Secretary may carry out activities to 
address documented workforce shortages in State and local health 
departments in the critical areas of applied public health epidemiology 
and public health laboratory science and informatics and may expand the 
Epidemic Intelligence Service.
    ``(b) Specific Uses.--In carrying out subsection (a), the Secretary 
shall provide for the expansion of existing fellowship programs 
operated through the Centers for Disease Control and Prevention in a 
manner that is designed to alleviate shortages of the type described in 
subsection (a).
    ``(c) Other Programs.--The Secretary may provide for the expansion 
of other applied epidemiology training programs that meet objectives 
similar to the objectives of the programs described in subsection (b).
    ``(d) Work Obligation.--Participation in fellowship training 
programs under this section shall be deemed to be service for purposes 
of satisfying work obligations stipulated in contracts under section 
338I(j).
    ``(e) General Support.--Amounts may be used from grants awarded 
under this section to expand the Public Health Informatics Fellowship 
Program at the Centers for Disease Control and Prevention to better 
support all public health systems at all levels of government.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $39,500,000 for each of fiscal 
years 2010 through 2013, of which--
            ``(1) $5,000,000 shall be made available in each such 
        fiscal year for epidemiology fellowship training program 
        activities under subsections (b) and (c);
            ``(2) $5,000,000 shall be made available in each such 
        fiscal year for laboratory fellowship training programs under 
        subsection (b);
            ``(3) $5,000,000 shall be made available in each such 
        fiscal year for the Public Health Informatics Fellowship 
        Program under subsection (e); and
            ``(4) $24,500,000 shall be made available for expanding the 
        Epidemic Intelligence Service under subsection (a).''.

SEC. 446. UNITED STATES PUBLIC HEALTH SCIENCES TRACK.

    Title II of the Public Health Service Act (42 U.S.C. 202 et seq.) 
is amended by adding at the end the following:

          ``PART D--UNITED STATES PUBLIC HEALTH SCIENCES TRACK

``SEC. 271. ESTABLISHMENT.

    ``(a) United States Public Health Services Track.--
            ``(1) In general.--There is hereby authorized to be 
        established a United States Public Health Sciences Track 
        (referred to in this part as the `Track'), at sites to be 
        selected by the Secretary, with authority to grant appropriate 
        advanced degrees in a manner that uniquely emphasizes team-
        based service, public health, epidemiology, and emergency 
        preparedness and response. It shall be so organized as to 
        graduate not less than--
                    ``(A) 150 medical students annually, 10 of whom 
                shall be awarded studentships to the Uniformed Services 
                University of Health Sciences;
                    ``(B) 100 dental students annually;
                    ``(C) 250 nursing students annually;
                    ``(D) 100 public health students annually;
                    ``(E) 100 behavioral and mental health professional 
                students annually;
                    ``(F) 100 physician assistant or nurse practitioner 
                students annually; and
                    ``(G) 50 pharmacy students annually.
            ``(2) Locations.--The Track shall be located at existing 
        and accredited, affiliated health professions education 
        training programs at academic health centers located in regions 
        of the United States determined appropriate by the Surgeon 
        General, in consultation with the National Health Care 
        Workforce Commission.
    ``(b) Number of Graduates.--Except as provided in subsection (a), 
the number of persons to be graduated from the Track shall be 
prescribed by the Secretary. In so prescribing the number of persons to 
be graduated from the Track, the Secretary shall institute actions 
necessary to ensure the maximum number of first-year enrollments in the 
Track consistent with the academic capacity of the affiliated sites and 
the needs of the United States for medical, dental, and nursing 
personnel.
    ``(c) Development.--The development of the Track may be by such 
phases as the Secretary may prescribe subject to the requirements of 
subsection (a).
    ``(d) Integrated Longitudinal Plan.--The Surgeon General shall 
develop an integrated longitudinal plan for health professions 
continuing education throughout the continuum of health-related 
education, training, and practice. Training under such plan shall 
emphasize patient-centered, interdisciplinary, and care coordination 
skills. Experience with deployment of emergency response teams shall be 
included during the clinical experiences.
    ``(e) Faculty Development.--The Surgeon General shall develop 
faculty development programs and curricula in decentralized venues of 
health care, to balance urban, tertiary, and inpatient venues.

``SEC. 272. ADMINISTRATION.

    ``(a) In General.--The business of the Track shall be conducted by 
the Surgeon General with funds appropriated for and provided by the 
Department of Health and Human Services. The National Health Workforce 
Commission shall assist the Surgeon General in an advisory capacity.
    ``(b) Faculty.--
            ``(1) In general.--The Surgeon General, after considering 
        the recommendations of the National Health Workforce 
        Commission, shall obtain the services of such professors, 
        instructors, and administrative and other employees as may be 
        necessary to operate the Track, but utilize when possible, 
        existing affiliated health professions training institutions. 
        Members of the faculty and staff shall be employed under salary 
        schedules and granted retirement and other related benefits 
        prescribed by the Secretary so as to place the employees of the 
        Track faculty on a comparable basis with the employees of fully 
        accredited schools of the health professions within the United 
        States.
            ``(2) Titles.--The Surgeon General may confer academic 
        titles, as appropriate, upon the members of the faculty.
            ``(3) Nonapplication of provisions.--The limitations in 
        section 5373 of title 5, United States Code, shall not apply to 
        the authority of the Surgeon General under paragraph (1) to 
        prescribe salary schedules and other related benefits.
    ``(c) Agreements.--The Surgeon General may negotiate agreements 
with agencies of the Federal Government to utilize on a reimbursable 
basis appropriate existing Federal medical resources located in the 
United States (or locations selected in accordance with section 
271(a)(2)). Under such agreements the facilities concerned will retain 
their identities and basic missions. The Surgeon General may negotiate 
affiliation agreements with accredited universities and health 
professions training institutions in the United States. Such agreements 
may include provisions for payments for educational services provided 
students participating in Department of Health and Human Services 
educational programs.
    ``(d) Programs.--The Surgeon General may establish the following 
educational programs for Track students:
            ``(1) Postdoctoral, postgraduate, and technological 
        programs.
            ``(2) A cooperative program for medical, dental, physician 
        assistant, pharmacy, behavioral and mental health, public 
        health, and nursing students.
            ``(3) Other programs that the Surgeon General determines 
        necessary in order to operate the Track in a cost-effective 
        manner.
    ``(e) Continuing Medical Education.--The Surgeon General shall 
establish programs in continuing medical education for members of the 
health professions to the end that high standards of health care may be 
maintained within the United States.
    ``(f) Authority of the Surgeon General.--
            ``(1) In general.--The Surgeon General is authorized--
                    ``(A) to enter into contracts with, accept grants 
                from, and make grants to any nonprofit entity for the 
                purpose of carrying out cooperative enterprises in 
                medical, dental, physician assistant, pharmacy, 
                behavioral and mental health, public health, and 
                nursing research, consultation, and education;
                    ``(B) to enter into contracts with entities under 
                which the Surgeon General may furnish the services of 
                such professional, technical, or clerical personnel as 
                may be necessary to fulfill cooperative enterprises 
                undertaken by the Track;
                    ``(C) to accept, hold, administer, invest, and 
                spend any gift, devise, or bequest of personal property 
                made to the Track, including any gift, devise, or 
                bequest for the support of an academic chair, teaching, 
                research, or demonstration project;
                    ``(D) to enter into agreements with entities that 
                may be utilized by the Track for the purpose of 
                enhancing the activities of the Track in education, 
                research, and technological applications of knowledge; 
                and
                    ``(E) to accept the voluntary services of guest 
                scholars and other persons.
            ``(2) Limitation.--The Surgeon General may not enter into 
        any contract with an entity if the contract would obligate the 
        Track to make outlays in advance of the enactment of budget 
        authority for such outlays.
            ``(3) Scientists.--Scientists or other medical, dental, or 
        nursing personnel utilized by the Track under an agreement 
        described in paragraph (1) may be appointed to any position 
        within the Track and may be permitted to perform such duties 
        within the Track as the Surgeon General may approve.
            ``(4) Volunteer services.--A person who provides voluntary 
        services under the authority of subparagraph (E) of paragraph 
        (1) shall be considered to be an employee of the Federal 
        Government for the purposes of chapter 81 of title 5, relating 
        to compensation for work-related injuries, and to be an 
        employee of the Federal Government for the purposes of chapter 
        171 of title 28, relating to tort claims. Such a person who is 
        not otherwise employed by the Federal Government shall not be 
        considered to be a Federal employee for any other purpose by 
        reason of the provision of such services.

``SEC. 273. STUDENTS; SELECTION; OBLIGATION.

    ``(a) Student Selection.--
            ``(1) In general.--Medical, dental, physician assistant, 
        pharmacy, behavioral and mental health, public health, and 
        nursing students at the Track shall be selected under 
        procedures prescribed by the Surgeon General. In so 
        prescribing, the Surgeon General shall consider the 
        recommendations of the National Health Workforce Commission.
            ``(2) Priority.--In developing admissions procedures under 
        paragraph (1), the Surgeon General shall ensure that such 
        procedures give priority to applicant medical, dental, 
        physician assistant, pharmacy, behavioral and mental health, 
        public health, and nursing students from rural communities and 
        underrepresented minorities.
    ``(b) Contract and Service Obligation.--
            ``(1) Contract.--Upon being admitted to the Track, a 
        medical, dental, physician assistant, pharmacy, behavioral and 
        mental health, public health, or nursing student shall enter 
        into a written contract with the Surgeon General that shall 
        contain--
                    ``(A) an agreement under which--
                            ``(i) subject to subparagraph (B), the 
                        Surgeon General agrees to provide the student 
                        with tuition (or tuition remission) and a 
                        student stipend (described in paragraph (2)) in 
                        each school year for a period of years (not to 
                        exceed 4 school years) determined by the 
                        student, during which period the student is 
                        enrolled in the Track at an affiliated or other 
                        participating health professions institution 
                        pursuant to an agreement between the Track and 
                        such institution; and
                            ``(ii) subject to subparagraph (B), the 
                        student agrees--
                                    ``(I) to accept the provision of 
                                such tuition and student stipend to the 
                                student;
                                    ``(II) to maintain enrollment at 
                                the Track until the student completes 
                                the course of study involved;
                                    ``(III) while enrolled in such 
                                course of study, to maintain an 
                                acceptable level of academic standing 
                                (as determined by the Surgeon General);
                                    ``(IV) if pursuing a degree from a 
                                school of medicine or osteopathic 
                                medicine, dental, public health, or 
                                nursing school or a physician 
                                assistant, pharmacy, or behavioral and 
                                mental health professional program, to 
                                complete a residency or internship in a 
                                specialty that the Surgeon General 
                                determines is appropriate; and
                                    ``(V) to serve for a period of time 
                                (referred to in this part as the 
                                `period of obligated service') within 
                                the Commissioned Corps of the Public 
                                Health Service equal to 2 years for 
                                each school year during which such 
                                individual was enrolled at the College, 
                                reduced as provided for in paragraph 
                                (3);
                    ``(B) a provision that any financial obligation of 
                the United States arising out of a contract entered 
                into under this part and any obligation of the student 
                which is conditioned thereon, is contingent upon funds 
                being appropriated to carry out this part;
                    ``(C) a statement of the damages to which the 
                United States is entitled for the student's breach of 
                the contract; and
                    ``(D) such other statements of the rights and 
                liabilities of the Secretary and of the individual, not 
                inconsistent with the provisions of this part.
            ``(2) Tuition and student stipend.--
                    ``(A) Tuition remission rates.--The Surgeon 
                General, based on the recommendations of the National 
                Health Workforce Commission established under section 
                411 of the Affordable Health Choices Act, shall 
                establish Federal tuition remission rates to be used by 
                the Track to provide reimbursement to affiliated and 
                other participating health professions institutions for 
                the cost of educational services provided by such 
                institutions to Track students. The agreement entered 
                into by such participating institutions under paragraph 
                (1)(A)(i) shall contain an agreement to accept as 
                payment in full the established remission rate under 
                this subparagraph.
                    ``(B) Stipend.--The Surgeon General, based on the 
                recommendations of the National Health Workforce 
                Commission, shall establish and update Federal stipend 
                rates for payment to students under this part.
            ``(3) Reductions in the period of obligated service.--The 
        period of obligated service under paragraph (1)(A)(ii)(V) shall 
        be reduced--
                    ``(A) in the case of a student who elects to 
                participate in a high-needs speciality residency (as 
                determined by the National Health Workforce 
                Commission), by 3 months for each year of such 
                participation (not to exceed a total of 12 months); and
                    ``(B) in the case of a student who, upon completion 
                of their residency, elects to practice in a Federal 
                medical facility (as defined in section 781(e)) that is 
                located in a health professional shortage area (as 
                defined in section 332), by 3 months for year of full-
                time practice in such a facility (not to exceed a total 
                of 12 months).
    ``(c) Second 2 Years of Service.--During the third and fourth years 
in which a medical, dental, physician assistant, pharmacy, behavioral 
and mental health, public health, or nursing student is enrolled in the 
Track, training should be designed to prioritize clinical rotations in 
Federal medical facilities in health professional shortage areas, and 
emphasize a balance of hospital and community-based experiences, and 
training within interdisciplinary teams.
    ``(d) Dentist, Physician Assistant, Pharmacist, Behavioral and 
Mental Health Professional, Public Health Professional, and Nurse 
Training.--The Surgeon General shall establish provisions applicable 
with respect to dental, physician assistant, pharmacy, behavioral and 
mental health, public health, and nursing students that are comparable 
to those for medical students under this section, including service 
obligations, tuition support, and stipend support. The Surgeon General 
shall give priority to health professions training institutions that 
train medical, dental, physician assistant, pharmacy, behavioral and 
mental health, public health, and nursing students for some significant 
period of time together, but at a minimum have a discrete and shared 
core curriculum.
    ``(e) Elite Federal Disaster Teams.--The Surgeon General, in 
consultation with the Secretary, the Director of the Centers for 
Disease Control and Prevention, and other appropriate military and 
Federal government agencies, shall develop criteria for the appointment 
of highly qualified Track faculty, medical, dental, physician 
assistant, pharmacy, behavioral and mental health, public health, and 
nursing students, and graduates to elite Federal disaster preparedness 
teams to train and to respond to public health emergencies, natural 
disasters, bioterrorism events, and other emergencies.
    ``(f) Student Dropped From Track in Affiliate School.--A medical, 
dental, physician assistant, pharmacy, behavioral and mental health, 
public health, or nursing student who, under regulations prescribed by 
the Surgeon General, is dropped from the Track in an affiliated school 
for deficiency in conduct or studies, or for other reasons, shall be 
liable to the United States for all tuition and stipend support 
provided to the student.

``SEC. 274. FUNDING.

    ``Beginning with fiscal year 2010, the Secretary shall transfer 
from the Public Health and Social Services Emergency Fund such sums as 
may be necessary to carry out this part.''.

       Subtitle E--Supporting the Existing Health Care Workforce

SEC. 451. CENTERS OF EXCELLENCE.

    Section 736 of the Public Health Service Act (42 U.S.C. 293) is 
amended by striking subsection (h) and inserting the following:
    ``(h) Formula for Allocations.--
            ``(1) Allocations.--Based on the amount appropriated under 
        subsection (i) for a fiscal year, the following subparagraphs 
        shall apply as appropriate:
                    ``(A) In general.--If the amounts appropriated 
                under subsection (i) for a fiscal year are $24,000,000 
                or less--
                            ``(i) the Secretary shall make available 
                        $12,000,000 for grants under subsection (a) to 
                        health professions schools that meet the 
                        conditions described in subsection (c)(2)(A); 
                        and
                            ``(ii) and available after grants are made 
                        with funds under clause (i), the Secretary 
                        shall make available--
                                    ``(I) 60 percent of such amount for 
                                grants under subsection (a) to health 
                                professions schools that meet the 
                                conditions described in paragraph (3) 
                                or (4) of subsection (c) (including 
                                meeting the conditions under subsection 
                                (e)); and
                                    ``(II) 40 percent of such amount 
                                for grants under subsection (a) to 
                                health professions schools that meet 
                                the conditions described in subsection 
                                (c)(5).
                    ``(B) Funding in excess of $24,000,000.--If amounts 
                appropriated under subsection (i) for a fiscal year 
                exceed $24,000,000 but are less than $30,000,000--
                            ``(i) 80 percent of such excess amounts 
                        shall be made available for grants under 
                        subsection (a) to health professions schools 
                        that meet the requirements described in 
                        paragraph (3) or (4) of subsection (c) 
                        (including meeting conditions pursuant to 
                        subsection (e)); and
                            ``(ii) 20 percent of such excess amount 
                        shall be made available for grants under 
                        subsection (a) to health professions schools 
                        that meet the conditions described in 
                        subsection (c)(5).
                    ``(C) Funding in excess of $30,000,000.--If amounts 
                appropriated under subsection (i) for a fiscal year 
                exceed $30,000,000 but are less than $40,000,000, the 
                Secretary shall make available--
                            ``(i) not less than $12,000,000 for grants 
                        under subsection (a) to health professions 
                        schools that meet the conditions described in 
                        subsection (c)(2)(A);
                            ``(ii) not less than $12,000,000 for grants 
                        under subsection (a) to health professions 
                        schools that meet the conditions described in 
                        paragraph (3) or (4) of subsection (c) 
                        (including meeting conditions pursuant to 
                        subsection (e));
                            ``(iii) not less than $6,000,000 for grants 
                        under subsection (a) to health professions 
                        schools that meet the conditions described in 
                        subsection (c)(5); and
                            ``(iv) after grants are made with funds 
                        under clauses (i) through (iii), any remaining 
                        excess amount for grants under subsection (a) 
                        to health professions schools that meet the 
                        conditions described in paragraph (2)(A), (3), 
                        (4), or (5) of subsection (c).
                    ``(D) Funding in excess of $40,000,000.--If amounts 
                appropriated under subsection (i) for a fiscal year are 
                $40,000,000 or more, the Secretary shall make 
                available--
                            ``(i) not less than $16,000,000 for grants 
                        under subsection (a) to health professions 
                        schools that meet the conditions described in 
                        subsection (c)(2)(A);
                            ``(ii) not less than $16,000,000 for grants 
                        under subsection (a) to health professions 
                        schools that meet the conditions described in 
                        paragraph (3) or (4) of subsection (c) 
                        (including meeting conditions pursuant to 
                        subsection (e));
                            ``(iii) not less than $8,000,000 for grants 
                        under subsection (a) to health professions 
                        schools that meet the conditions described in 
                        subsection (c)(5); and
                            ``(iv) after grants are made with funds 
                        under clauses (i) through (iii), any remaining 
                        funds for grants under subsection (a) to health 
                        professions schools that meet the conditions 
                        described in paragraph (2)(A), (3), (4), or (5) 
                        of subsection (c).
            ``(2) No limitation.--Nothing in this subsection shall be 
        construed as limiting the centers of excellence referred to in 
        this section to the designated amount, or to preclude such 
        entities from competing for grants under this section.
            ``(3) Maintenance of effort.--
                    ``(A) In general.--With respect to activities for 
                which a grant made under this part are authorized to be 
                expended, the Secretary may not make such a grant to a 
                center of excellence for any fiscal year unless the 
                center agrees to maintain expenditures of non-Federal 
                amounts for such activities at a level that is not less 
                than the level of such expenditures maintained by the 
                center for the fiscal year preceding the fiscal year 
                for which the school receives such a grant.
                    ``(B) Use of federal funds.--With respect to any 
                Federal amounts received by a center of excellence and 
                available for carrying out activities for which a grant 
                under this part is authorized to be expended, the 
                center shall, before expending the grant, expend the 
                Federal amounts obtained from sources other than the 
                grant, unless given prior approval from the Secretary.
    ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section--
            ``(1) $50,000,000 for each of the fiscal years 2010 through 
        2015; and
            ``(2) and such sums as are necessary for each subsequent 
        fiscal year.''.

SEC. 452. HEALTH CARE PROFESSIONALS TRAINING FOR DIVERSITY.

    (a) Loan Repayments and Fellowships Regarding Faculty Positions.--
Section 738(a)(1) of the Public Health Service Act (42 U.S.C. 
293b(a)(1)) is amended by striking ``$20,000 of the principal and 
interest of the educational loans of such individuals.'' and inserting 
``$30,000 of the principal and interest of the educational loans of 
such individuals.''.
    (b) Scholarships for Disadvantaged Students.--Section 740(a) of 
such Act (42 U.S.C. 293d(a)) is amended by striking ``$37,000,000'' and 
all that follows through ``2002'' and inserting ``$51,000,000 for 
fiscal year 2010, and such sums as may be necessary for each of the 
fiscal years 2011 through 2014''.
    (c) Reauthorization for Loan Repayments and Fellowships Regarding 
Faculty Positions.--Section 740(b) of such Act (42 U.S.C. 293d(b)) is 
amended by striking ``appropriated'' and all that follows through the 
period at the end and inserting ``appropriated, $5,000,000 for each of 
the fiscal years 2010 through 2014.''.
    (d) Reauthorization for Educational Assistance in the Health 
Professions Regarding Individuals From a Disadvantaged Background.--
Section 740(c) of such Act (42 U.S.C. 293d(c)) is amended by striking 
the first sentence and inserting the following: ``For the purpose of 
grants and contracts under section 739(a)(1), there is authorized to be 
appropriated $60,000,000 for fiscal year 2010 and such sums as may be 
necessary for each of the fiscal years 2011 through 2014.''

SEC. 453. INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES.

    (a) Area Health Education Centers.--Section 751 of the Public 
Health Service Act (42 U.S.C. 294a) is amended to read as follows:

``SEC. 751. AREA HEALTH EDUCATION CENTERS.

    ``(a) Establishment of Awards.--The Secretary shall make awards in 
accordance with this section.
    ``(b) Infrastructure Development Award.--
            ``(1) In general.--The Secretary shall make awards to 
        eligible entities to enable such entities to initiate health 
        care workforce educational programs or to continue to carry out 
        comparable programs that are operating at the time the award is 
        made by planning, developing, operating, and evaluating of an 
        area health education center program.
            ``(2) Eligible entity.--For purposes of this subsection, an 
        `eligible entity' means a school of medicine or osteopathic 
        medicine, an incorporated consortium of such schools, or the 
        parent institutions of such a school. With respect to a State 
        in which no area health education center program is in 
        operation, the Secretary may award a grant or contract under 
        paragraph (1) to a school of nursing.
            ``(3) Application.--An eligible entity desiring to receive 
        an award under this subsection shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require.
            ``(4) Use of funds.--
                    ``(A) Required activities.--An eligible entity 
                shall use amounts awarded under a grant under paragraph 
                (1) to carry out the following activities:
                            ``(i) Develop and implement strategies, in 
                        coordination with the applicable one-stop 
                        delivery system under section 134(c) of the 
                        Workforce Investment Act of 1998, to recruit 
                        individuals from underrepresented minority 
                        populations or from disadvantaged or rural 
                        backgrounds into health professions, and 
                        support such individuals in attaining such 
                        careers.
                            ``(ii) Develop and implement strategies to 
                        foster and provide community-based training and 
                        education to individuals seeking careers in 
                        health professions within underserved areas for 
                        the purpose of developing and maintaining a 
                        diverse health care workforce that is prepared 
                        to deliver high-quality care, with an emphasis 
                        on primary care, in underserved areas or for 
                        health disparity populations, in collaboration 
                        with other Federal and State health care 
                        workforce development programs, the State 
                        workforce agency, and local workforce 
                        investment boards, and in health care safety 
                        net sites.
                            ``(iii) Prepare individuals to more 
                        effectively provide health services to 
                        underserved areas and health disparity 
                        populations through field placements or 
                        preceptorships in conjunction with community-
                        based organizations, accredited primary care 
                        residency training programs, Federally 
                        qualified health centers, rural health clinics, 
                        public health departments, or other appropriate 
                        facilities.
                            ``(iv) Conduct and participate in 
                        interdisciplinary training that involves 
                        physicians, physician assistants, nurse 
                        practitioners, nurse midwives, dentists, 
                        psychologists, pharmacists, optometrists, 
                        community health workers, public and allied 
                        health professionals, or other health 
                        professionals, as practicable.
                            ``(v) Deliver or facilitate continuing 
                        education and information dissemination 
                        programs for health care professionals, with an 
                        emphasis on individuals providing care in 
                        underserved areas and for health disparity 
                        populations.
                            ``(vi) Propose and implement effective 
                        program and outcomes measurement and evaluation 
                        strategies.
                    ``(B) Innovative opportunities.--An eligible entity 
                may use amounts awarded under a grant under paragraph 
                (1) to carry out any of the following activities:
                            ``(i) Develop and implement innovative 
                        curricula in collaboration with community-based 
                        accredited primary care residency training 
                        programs, Federally qualified health centers, 
                        rural health clinics, behavioral and mental 
                        health facilities, public health departments, 
                        or other appropriate facilities, with the goal 
                        of increasing the number of primary care 
                        physicians and other primary care providers 
                        prepared to serve in underserved areas and 
                        health disparity populations.
                            ``(ii) Coordinate community-based 
                        participatory research with academic health 
                        centers, and facilitate rapid flow and 
                        dissemination of evidence-based health care 
                        information, research results, and best 
                        practices to improve quality, efficiency, and 
                        effectiveness of health care and health care 
                        systems within community settings.
                            ``(iii) Develop and implement other 
                        strategies to address identified workforce 
                        needs and increase and enhance the health care 
                        workforce in the area served by the area health 
                        education center program.
    ``(c) Point of Service Maintenance and Enhancement Award.--
            ``(1) In general.--The Secretary shall make awards to 
        eligible entities to maintain and improve the effectiveness and 
        capabilities of an existing area health education center 
        program, and make other modifications to the program that are 
        appropriate due to changes in demographics, needs of the 
        populations served, or other similar issues affecting the 
        program.
            ``(2) Eligible entity.--For purposes of this subsection, 
        the term `eligible entity' means an entity that has received 
        funds under this section (as this section was in effect on the 
        day before the date of enactment of the Affordable Health 
        Choices Act), is operating an area health education center 
        program, including area health education centers, and has a 
        center or centers that are no longer eligible to receive 
        financial assistance under subsection (b).
            ``(3) Application.--An eligible entity desiring to receive 
        an award under this subsection shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require.
            ``(4) Use of funds.--
                    ``(A) Required activities.--An eligible entity 
                shall use amounts awarded under a grant under paragraph 
                (1) to carry out the following activities:
                            ``(i) Develop and implement strategies in 
                        coordination with the applicable one-stop 
                        delivery system under section 134(c) of the 
                        Workforce Investment Act of 1998 to recruit 
                        individuals from underrepresented minority 
                        groups, underserved areas, or with rural 
                        backgrounds into health care careers, and 
                        support such individuals in attaining such 
                        careers.
                            ``(ii) Develop and implement strategies to 
                        foster and provide community-based training and 
                        education to individuals seeking careers in 
                        health professions within underserved areas for 
                        the purpose of developing and maintaining a 
                        diverse health care workforce that is prepared 
                        to deliver high-quality care, with an emphasis 
                        on primary care, in underserved areas and to 
                        health disparity populations, in collaboration 
                        with other Federal and State health care 
                        workforce development programs, and in health 
                        care safety net sites.
                            ``(iii) Prepare individuals to more 
                        effectively provide health services to 
                        underserved areas or health disparity 
                        populations through field placements or 
                        preceptorships in conjunction with community-
                        based organizations, accredited primary care 
                        residency training programs, Federally 
                        qualified health centers, rural health clinics, 
                        behavioral and mental health facilities, public 
                        health departments, or other appropriate 
                        facilities.
                            ``(iv) Conduct and participate in 
                        interdisciplinary training that involves 
                        physicians, physician assistants, nurse 
                        practitioners, nurse midwives, dentists, 
                        psychologists, pharmacists, optometrists, 
                        community health workers, public and allied 
                        health professionals, or other health 
                        professionals, as practicable.
                            ``(v) Deliver or facilitate continuing 
                        education and information dissemination 
                        programs for health care professionals, with an 
                        emphasis on individuals providing care in 
                        underserved areas and for health disparity 
                        populations.
                            ``(vi) Propose and implement effective 
                        program and outcomes measurement and evaluation 
                        strategies.
                    ``(B) Innovative opportunities.--An eligible entity 
                shall use amounts awarded under a grant under paragraph 
                (1) to carry out at least 1 of the following 
                activities:
                            ``(i) Develop innovative curricula in 
                        collaboration with community-based accredited 
                        primary care residency training programs, 
                        Federally qualified health centers, rural 
                        health clinics, behavioral and mental health 
                        facilities, public health departments, or other 
                        appropriate facilities, with the goal of 
                        increasing the number of primary care 
                        physicians and other primary care providers 
                        prepared to serve in underserved areas and 
                        health disparity populations.
                            ``(ii) Coordinate community-based 
                        participatory research with academic health 
                        centers, and facilitate rapid flow and 
                        dissemination of evidence-based health care 
                        information, research results, and best 
                        practices to improve quality, efficiency, and 
                        effectiveness of health care and health care 
                        systems within community settings.
                            ``(iii) Develop and implement other 
                        strategies to address identified workforce 
                        needs and increase and enhance the health care 
                        workforce in the area served by the area health 
                        education center program.
    ``(d) Requirements.--
            ``(1) Area health education center program.--In carrying 
        out this section, the Secretary shall ensure the following:
                    ``(A) An entity that receives an award under this 
                section shall conduct at least 10 percent of clinical 
                education required for medical students in community 
                settings that are removed from the primary teaching 
                facility of the contracting institution for grantees 
                that operate a school of medicine or osteopathic 
                medicine. In States in which an entity that receives an 
                award under this section is a nursing school or its 
                parent institution, the Secretary shall alternatively 
                ensure that--
                            ``(i) the nursing school places at least 10 
                        percent of its students in training sites 
                        affiliated with an area health education center 
                        that is remote from the primary teaching 
                        facility of the school; and
                            ``(ii) the entity receiving the award 
                        maintains a written agreement with a school of 
                        medicine or osteopathic medicine to place at 
                        least 10 percent of students from that school 
                        in training sites in the area health education 
                        center program area.
                    ``(B) An entity receiving funds under subsection 
                (c) does not distribute such funding to a center that 
                is eligible to receive funding under subsection (b).
            ``(2) Area health education center.--The Secretary shall 
        ensure that each area health education center program includes 
        at least 1 area health education center, and that each such 
        center--
                    ``(A) is a public or private organization whose 
                structure, governance, and operation is independent 
                from the awardee and the parent institution of the 
                awardee;
                    ``(B) is not a school of medicine or osteopathic 
                medicine, the parent institution of such a school, or a 
                branch campus or other subunit of a school of medicine 
                or osteopathic medicine or its parent institution, or a 
                consortium of such entities;
                    ``(C) designates an underserved area or population 
                to be served by the center which is in a location 
                removed from the main location of the teaching 
                facilities of the schools participating in the program 
                with such center and does not duplicate, in whole or in 
                part, the geographic area or population served by any 
                other center;
                    ``(D) fosters networking and collaboration among 
                communities and between academic health centers and 
                community-based centers;
                    ``(E) serves communities with a demonstrated need 
                of health professionals in partnership with academic 
                medical centers;
                    ``(F) addresses the health care workforce needs of 
                the communities served in coordination with the public 
                workforce investment system; and
                    ``(G) has a community-based governing or advisory 
                board that reflects the diversity of the communities 
                involved.
    ``(e) Matching Funds.--With respect to the costs of operating a 
program through a grant under this section, to be eligible for 
financial assistance under this section, an entity shall make available 
(directly or through contributions from State, county or municipal 
governments, or the private sector) recurring non-Federal contributions 
in cash or in kind, toward such costs in an amount that is equal to not 
less than 50 percent of such costs. At least 25 percent of the total 
required non-Federal contributions shall be in cash. An entity may 
apply to the Secretary for a waiver of not more than 75 percent of the 
matching fund amount required by the entity for each of the first 3 
years the entity is funded through a grant under subsection (b).
    ``(f) Limitation.--Not less than 75 percent of the total amount 
provided to an area health education center program under subsection 
(b) or (c) shall be allocated to the area health education centers 
participating in the program under this section. To provide needed 
flexibility to newly funded area health education center programs, the 
Secretary may waive the requirement in the sentence for the first 2 
years of a new area health education center program funded under 
subsection (b).
    ``(g) Award.--An award to an entity under this section shall be not 
less than $250,000 annually per area health education center included 
in the program involved. If amounts appropriated to carry out this 
section are not sufficient to comply with the preceding sentence, the 
Secretary may reduce the per center amount provided for in such 
sentence as necessary, provided the distribution established in 
subsection (k)(2) is maintained.
    ``(h) Project Terms.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        period during which payments may be made under an award under 
        subsection (b) may not exceed--
                    ``(A) in the case of a program, 12 years; or
                    ``(B) in the case of a center within a program, 6 
                years.
            ``(2) Exception.--The periods described in paragraph (1) 
        shall not apply to programs receiving point of service 
        maintenance and enhancement awards under subsection (c) to 
        maintain existing centers and activities.
    ``(i) Inapplicability of Provision.--Notwithstanding any other 
provision of this title, section 791(a) shall not apply to an area 
health education center funded under this section.
    ``(j) Authorization of Appropriations.--
            ``(1) In general.--There is authorized to be appropriated 
        to carry out this section $125,000,000 for each of the fiscal 
        years 2010 through 2014.
            ``(2) Requirements.--Of the amounts appropriated for a 
        fiscal year under paragraph (1)--
                    ``(A) not more than 35 percent shall be used for 
                awards under subsection (b);
                    ``(B) not less than 60 percent shall be used for 
                awards under subsection (c);
                    ``(C) not more than 1 percent shall be used for 
                grants and contracts to implement outcomes evaluation 
                for the area health education centers; and
                    ``(D) not more than 4 percent shall be used for 
                grants and contracts to provide technical assistance to 
                entities receiving awards under this section.
            ``(3) Carryover funds.--An entity that receives an award 
        under this section may carry over funds from 1 fiscal year to 
        another without obtaining approval from the Secretary. In no 
        case may any funds be carried over pursuant to the preceding 
        sentence for more than 3 years.
    ``(k) Sense of Congress.--It is the sense of the Congress that 
every State have an area health education center program in effect 
under this section.''.
    (b) Continuing Educational Support for Health Professionals Serving 
in Underserved Communities.--Part D of title VII of the Public Health 
Service Act (42 U.S.C. 294 et seq.) is amended by striking section 752 
and inserting the following:

``SEC. 752. CONTINUING EDUCATIONAL SUPPORT FOR HEALTH PROFESSIONALS 
              SERVING IN UNDERSERVED COMMUNITIES.

    ``(a) In General.--The Secretary shall make grants to, and enter 
into contracts with, eligible entities to improve health care, increase 
retention, increase representation of minority faculty members, enhance 
the practice environment, and provide information dissemination and 
educational support to reduce professional isolation through the timely 
dissemination of research findings using relevant resources.
    ``(b) Eligible Entities.--For purposes of this section, the term 
`eligible entity' means an entity described in section 799(b).
    ``(c) Application.--An eligible entity desiring to receive an award 
under this section shall submit to the Secretary an application at such 
time, in such manner, and containing such information as the Secretary 
may require.
    ``(d) Use of Funds.--An eligible entity shall use amounts awarded 
under a grant or contract under this section to provide innovative 
supportive activities to enhance education through distance learning, 
continuing educational activities, collaborative conferences, and 
electronic and telelearning activities, with priority for primary care.
    ``(e) Authorization.--There is authorized to be appropriated to 
carry out this section $5,000,000 for each of the fiscal years 2010 
through 2014, and such sums as may be necessary for each subsequent 
fiscal year.''.

SEC. 454. WORKFORCE DIVERSITY GRANTS.

    Section 821 of the Public Health Service Act (42 U.S.C. 296m) is 
amended--
            (1) in subsection (a)--
                    (A) by striking ``The Secretary may'' and inserting 
                the following:
            ``(1) Authority.--The Secretary may'';
                    (B) by striking ``pre-entry preparation, and 
                retention activities'' and inserting the following: 
                ``stipends for diploma or associate degree nurses to 
                enter a bridge or degree completion program, student 
                scholarships or stipends for accelerated nursing degree 
                programs, pre-entry preparation, advanced education 
                preparation, and retention activities''; and
            (2) in subsection (b)--
                    (A) by striking ``First'' and all that follows 
                through ``including the'' and inserting ``National 
                Advisory Council on Nurse Education and Practice and 
                consult with nursing associations including the 
                National Coalition of Ethnic Minority Nurse 
                Associations,''; and
                    (B) by inserting before the period the following: 
                ``, and other organizations determined appropriate by 
                the Secretary''.

SEC. 455. PRIMARY CARE EXTENSION PROGRAM.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 443, is further amended by adding 
at the end the following:

``SEC. 399V. PRIMARY CARE EXTENSION PROGRAM.

    ``(a) Establishment, Purpose and Definition.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Agency for Healthcare Research and Quality, 
        shall establish a Primary Care Extension Program.
            ``(2) Purpose.--The Primary Care Extension Program shall 
        provide support and assistance to primary care providers to 
        educate providers about preventive medicine, health promotion, 
        chronic disease management, mental and behavioral health 
        services (including substance abuse prevention and treatment 
        services), and evidence-based and evidence-informed therapies 
        and techniques, in order to enable providers to incorporate 
        such matters into their practice and to improve community 
        health by working with community-based health connectors 
        (referred to in this section as `Health Extension Agents').
            ``(3) Definitions.--In this section:
                    ``(A) Health extension agent.--The term `Health 
                Extension Agent' means any local, community-based 
                health worker who facilitates and provides assistance 
                to primary care practices by implementing quality 
                improvement or system redesign, incorporating the 
                principles of the patient-centered medical home to 
                provide high-quality, effective, efficient, and safe 
                primary care and to provide guidance to patients in 
                culturally and linguistically appropriate ways, and 
                linking practices to diverse health system resources.
                    ``(B) Primary care provider.--The term `primary 
                care provider' means a clinician who provides 
                integrated, accessible health care services and who is 
                accountable for addressing a large majority of personal 
                health care needs, including providing preventive and 
                health promotion services for men, women, and children 
                of all ages, developing a sustained partnership with 
                patients, and practicing in the context of family and 
                community, as recognized by a State licensing or 
                regulatory authority, unless otherwise specified in 
                this section.
    ``(b) Grants to Establish State Hubs and Local Primary Care 
Extension Agencies.--
            ``(1) Grants.--The Secretary shall award competitive grants 
        to States for the establishment of State- or multistate-level 
        primary care Primary Care Extension Program State Hubs 
        (referred to in this section as `Hubs').
            ``(2) Composition of hubs.--A Hub established by a State 
        pursuant to paragraph (1)--
                    ``(A) shall consist of, at a minimum, the State 
                health department, the entity responsible for 
                administering the State Medicaid program (if other than 
                the State health department), the State-level entity 
                administering the Medicare program, and the departments 
                of 1 or more health professions schools in the State 
                that train providers in primary care; and
                    ``(B) may include entities such as hospital 
                associations, primary care practice-based research 
                networks, health professional societies, State primary 
                care associations, State licensing boards, 
                organizations with a contract with the Secretary under 
                section 1153 of the Social Security Act, consumer 
                groups, and other appropriate entities.
    ``(c) State and Local Activities.--
            ``(1) Hub activities.--Hubs established under a grant under 
        subsection (b) shall--
                    ``(A) submit to the Secretary a plan to coordinate 
                functions with quality improvement organizations and 
                area health education centers if such entities are 
                members of the Hub not described in subsection 
                (b)(2)(A);
                    ``(B) contract with a county- or local-level entity 
                that shall serve as the Primary Care Extension Agency 
                to administer the services described in paragraph (2);
                    ``(C) organize and administer grant funds to 
                county- or local-level Primary Care Extension Agencies 
                that serve a catchment area, as determined by the 
                State; and
                    ``(D) organize State-wide or multistate networks of 
                local-level Primary Care Extension Agencies to share 
                and disseminate information and practices.
            ``(2) Local primary care extension agency activities.--
                    ``(A) Required activities.--Primary Care Extension 
                Agencies established by a Hub under paragraph (1) 
                shall--
                            ``(i) assist primary care providers to 
                        implement a patient-centered medical home to 
                        improve the accessibility, quality, and 
                        efficiency of primary care services;
                            ``(ii) develop and support primary care 
                        learning communities to enhance the 
                        dissemination of research findings for 
                        evidence-based practice, assess implementation 
                        of practice improvement, share best practices, 
                        and involve community clinicians in the 
                        generation of new knowledge and identification 
                        of important questions for research;
                            ``(iii) participate in a national network 
                        of Primary Care Extension Hubs and propose how 
                        the Primary Care Extension Agency will share 
                        and disseminate lessons learned and best 
                        practices; and
                            ``(iv) develop a plan for financial 
                        sustainability involving State, local, and 
                        private contributions, to provide for the 
                        reduction in Federal funds that is expected 
                        after an initial 6-year period of program 
                        establishment, infrastructure development, and 
                        planning.
                    ``(B) Discretionary activities.--Primary Care 
                Extension Agencies established by a Hub under paragraph 
                (1) may--
                            ``(i) provide technical assistance, 
                        training, and organizational support for 
                        community health teams established under 
                        section 212 of the Affordable Health Choices 
                        Act;
                            ``(ii) collect data and provision of 
                        primary care provider feedback from 
                        standardized measurements of processes and 
                        outcomes to aid in continuous performance 
                        improvement;
                            ``(iii) collaborate with local health 
                        departments, community health centers, tribes 
                        and tribal entities, and other community 
                        agencies to identify community health 
                        priorities and local health workforce needs, 
                        and participate in community-based efforts to 
                        address the social and primary determinants of 
                        health, strengthen the local primary care 
                        workforce, and eliminate health disparities;
                            ``(iv) develop measures to monitor the 
                        impact of the proposed program on the health of 
                        practice enrollees and of the wider community 
                        served; and
                            ``(v) participate in other activities, as 
                        determined appropriate by the Secretary.
    ``(d) Federal Program Administration.--
            ``(1) Grants; types.--Grants awarded under subsection (b) 
        shall be--
                    ``(A) program grants, that are awarded to State or 
                multistate entities that submit fully-developed plans 
                for the implementation of a Hub, for a period of 6 
                years; or
                    ``(B) planning grants, that are awarded to State or 
                multistate entities with the goal of developing a plan 
                for a Hub, for a period of 2 years.
            ``(2) Applications.--To be eligible for a grant under 
        subsection (b), a State or multistate entity shall submit to 
        the Secretary an application, at such time, in such manner, and 
        containing such information as the Secretary may require.
            ``(3) Evaluation.--A State that receives a grant under 
        subsection (b) shall be evaluated at the end of the grant 
        period by an evaluation panel appointed by the Secretary.
            ``(4) Continuing support.--After the sixth year in which 
        assistance is provided to a State under a grant awarded under 
        subsection (b), the State may receive additional support under 
        this section if the State program has received satisfactory 
        evaluations with respect to program performance and the merits 
        of the State sustainability plan, as determined by the 
        Secretary.
            ``(5) Limitation.--A State shall not use in excess of 10 
        percent of the amount received under a grant to carry out 
        administrative activities under this section. Funds awarded 
        pursuant to this section shall not be used for funding direct 
        patient care.
    ``(e) Requirements on the Secretary.--In carrying out this section, 
the Secretary shall consult with the heads of other Federal agencies 
with demonstrated experience and expertise in health care and 
preventive medicine, such as the Centers for Disease Control and 
Prevention, the Substance Abuse and Mental Health Administration, the 
Health Resources and Services Administration, the National Institutes 
of Health, the Office of the National Coordinator for Health 
Information Technology, the Indian Health Service, the Agricultural 
Cooperative Extension Service of the Department of Agriculture, and 
other entities, as the Secretary determines appropriate.
    ``(f) Authorization of Appropriations.--To awards grants as 
provided in subsection (d), there are authorized to be appropriated 
$120,000,000 for each of fiscal years 2011 and 2012, and such sums as 
may be necessary to carry out this section for each of fiscal years 
2013 through 2014.''.

SEC. 456. DEFINITION OF ECONOMIC HARDSHIP.

    Section 435(o) of the Higher Education Act of 1965 (20 U.S.C. 
1085(o)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A)(ii), by striking ``or'' 
                after the semicolon;
                    (B) by redesignating subparagraph (B) as 
                subparagraph (C); and
                    (C) by inserting after subparagraph (A) the 
                following:
                    ``(B) such borrower is working full-time and has a 
                Federal educational debt burden that equals or exceeds 
                20 percent of such borrower's adjusted gross income, 
                and the difference between such borrower's adjusted 
                gross income minus such burden is less than 220 percent 
                of the greater of--
                            ``(i) the annual earnings of an individual 
                        earning the minimum wage under section 6 of the 
                        Fair Labor Standards Act of 1938; or
                            ``(ii) 150 percent of the poverty line, as 
                        defined under section 673(2) of the Community 
                        Services Block Grant Act, applicable to such 
                        borrower's family size; or''; and
            (2) in paragraph (2), by striking ``(1)(B)'' and inserting 
        ``(1)(C)''.

                     Subtitle F--General Provisions

SEC. 461. REPORTS.

    (a) Reports by Secretary of Health and Human Services.--On an 
annual basis, the Secretary of Health and Human Services shall submit 
to the appropriate Committees of Congress a report on the activities 
carried out under the amendments made by this title, and the 
effectiveness of such activities.
    (b) Reports by Recipients of Funds.--The Secretary of Health and 
Human Services may require, as a condition of receiving funds under the 
amendments made by this title, that the entity receiving such award 
submit to such Secretary such reports as the such Secretary may require 
on activities carried out with such award, and the effectiveness of 
such activities.

                  TITLE V--PREVENTING FRAUD AND ABUSE

    Subtitle A--Establishment of New Health and Human Services and 
           Department of Justice Health Care Fraud Positions

SEC. 501. HEALTH AND HUMAN SERVICES SENIOR ADVISOR.

    Part C of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-91 et seq.) is amended--
            (1) by redesignating section 2792 as section 2796; and
            (2) by inserting after section 2791, the following:

``SEC. 2792. SENIOR ADVISOR FOR HEALTH CARE FRAUD.

    ``(a) Establishment.--The Secretary shall appoint an individual to 
serve as the Senior Advisor for Health Care Fraud (referred to in this 
section as the `Senior Advisor') within the Office of the Deputy 
Secretary. The Senior Advisory shall be the principal advisor on policy 
and program development and oversight with respect to--
            ``(1) the detection and prevention of health care fraud, 
        waste, and abuse involving public health insurance coverage and 
        private health insurance coverage; and
            ``(2) the coordination of anti-fraud efforts within the 
        Department of Health and Human Services and with the Inspector 
        General, the Department of Justice, other Federal agencies as 
        appropriate, State and local law enforcement, State regulatory 
        agencies, and private health insurance coverage.
    ``(b) Requirements.--The Senior Advisor shall--
            ``(1) be an officer or employee of the Department of Health 
        and Human Services designated by the Secretary for purposes of 
        this section from among the career officers and employees of 
        the Department who have the experience and expertise necessary 
        to carry out the duties specified in subsection (a); or
            ``(2) be an individual hired by the Secretary from the 
        private sector from among individuals in the private sector who 
        have the experience and expertise necessary to carry out the 
        duties specified in subsection (a).
    ``(c) Definition.--In this section, the term `public health 
insurance coverage' means coverage--
            ``(1) provided under title XVIII, XIX, or XXI of the Social 
        Security Act;
            ``(2) provided under the veteran's health care program 
        under chapter 17 of title 38, United States Code;
            ``(3) provided through the Indian Health Service;
            ``(4) under the TRICARE program under chapter 55 of title 
        10, United States Code; and
            ``(5) under the Federal Employees Health Benefits Program 
        under chapter 89 of title 5, United States Code.''.

SEC. 502. DEPARTMENT OF JUSTICE POSITION.

    Chapter 41 of title 28, United States Code, is amended by adding at 
the end the following:
``Sec. 614. Senior Counsel for Health Care Fraud Enforcement
    ``The Attorney General shall appoint an individual to serve as the 
Senior Counsel for Health Care Fraud Enforcement (referred to in this 
section as the `Senior Counsel') within the Office of the Deputy 
Attorney General to serve as the principal advisor to the Attorney 
General on policy and program development and oversight with respect 
to--
            ``(1) the investigation and prosecution of health care 
        fraud and abuse involving public and private health insurance 
        coverage (as defined in section 2791 of the Public Health 
        Service Act); and
            ``(2) the coordination of such efforts within the 
        Department of Justice and with the Inspector General, the 
        Department of Health and Human Services, other Federal agencies 
        as appropriate, State and local law enforcement, State 
        regulatory agencies, and private health insurance coverage.''.

SEC. 503. REPORTS TO CONGRESS.

    (a) Reports.--The Senior Advisor for Health Care Fraud appointed 
under section 2792 of the Public Health Service Act and the Senior 
Counsel for Health Care Fraud Enforcement appointed under section 614 
of title 28, United States Code, shall annually report to the Committee 
On Health, Education, Labor, and Pensions and the Committee on Finance 
of the Senate and the Committee on Ways and Means of the House of 
Representatives regarding the detection and prevention of health care 
fraud, waste, and abuse involving public health insurance and private 
health insurance coverage.
    (b) Definition.--In this section, the term ``public health 
insurance coverage'' means coverage--
            (1) provided under title XVIII, XIX, or XXI of the Social 
        Security Act;
            (2) provided under the veteran's health care program under 
        chapter 17 of title 38, United States Code;
            (3) provided through the Indian Health Service;
            (4) under the TRICARE program under chapter 55 of title 10, 
        United States Code; and
            (5) under the Federal Employees Health Benefits Program 
        under chapter 89 of title 5, United States Code.

SEC. 504. FRAUD, WASTE, AND ABUSE COMMISSION.

    (a) Establishment.--Not later than 180 days after the date of 
enactment of this Act, the President shall establish a commission to be 
composed of representatives appointed by the President from insurers, 
employers, health care providers, anti-fraud organizations, consumers 
and patient groups, and Federal officials to review Federal health care 
programs and private health insurance with respect to policies and 
procedures to eliminate fraud, waste, and abuse under such programs and 
to more effectively align public and private sector efforts to combat 
fraud, waste, and abuse.
    (b) Period of Review.--The commission under subsection (a) shall 
review the programs involved for a period of 2 years following the date 
on which such commission is established.
    (c) Report.--Not later than 3 years after the date on which the 
commission under subsection (a) is established, the commission shall 
submit to the Committee on Health, Education, Labor, and Pensions and 
the Committee on Finance of the Senate and the Committee on Ways and 
Means and the Committee on Energy and Commerce of the House of 
Representatives a report concerning the review conducted under such 
subsection. Such report shall include recommendations for modify such 
programs and other recommendations to better coordinate public and 
private efforts to combat fraud and abuse.
    (d) Cooperation.--The President shall direct Federal officials to 
cooperate in the activities of the commission under this section. 
Commissioners shall have experience in fighting waste, fraud or abuse 
in the public and private sectors.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000.

     Subtitle B--Health Care Program Integrity Coordinating Council

SEC. 511. ESTABLISHMENT.

    Part C of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-91 et seq.), as amended by section 501, is further amended by 
inserting after section 2793, the following:

``SEC. 2794. HEALTH CARE PROGRAM INTEGRITY COORDINATING COUNCIL.

    ``(a) Establishment.--There is established a council to be known as 
the `Health Care Program Integrity Coordinating Council' (referred to 
in this section as the `Council').
    ``(b) Membership.--The Council shall be composed of--
            ``(1) the Secretary of Health and Human Services;
            ``(2) the Attorney General;
            ``(3) the Inspector General for the Department of Health 
        and Human Services;
            ``(4) the Secretary of Labor;
            ``(5) the Secretary of Defense;
            ``(6) the Director of the Office of Personnel Management;
            ``(7) the Under Secretary for Health for the Veterans 
        Health Administration of the Department of Veterans Affairs;
            ``(8) the Commissioner of the Social Security 
        Administration;
            ``(9) the President of the National Association of 
        Insurance Commissioners;
            ``(10) the President of the National Association of 
        Medicaid Fraud Control Units;
            ``(11) the Comptroller General of the United States;
            ``(12) the Inspector General of the Department of Labor;
            ``(13) the Inspector General of the Department of Defense;
            ``(14) the Inspector General of the Department of Veterans 
        Affairs;
            ``(15) the Inspector General of the Department of Justice;
            ``(16) the chairperson and ranking member of relevant 
        committees of jurisdiction of the Senate and the House of 
        Representatives; and
            ``(17) any other member, the appointment of whom a majority 
        of the members of the Council determines is necessary to carry 
        out this title, except that an individual who is a 
        representative of an entity subject to regulation under such 
        Act shall not be appointed under this subparagraph.
    ``(c) Duties.--The Council shall--
            ``(1) not later than 6 months after the date of enactment 
        of this section, develop a strategic plan for improving the 
        coordination and information sharing among Federal agencies, 
        State agencies, and private health insurance coverage with 
        respect to the prevention, detection, and control of fraud, 
        waste, and abuse, including fraud and abuse of consumers of the 
        health care program or private health insurance issuers;
            ``(2) annually submit to Congress a report on actions taken 
        to implement the strategic plan required under paragraph (1);
            ``(3) in carrying out the responsibilities identified under 
        paragraph (1), evaluate ways to ensure that private health 
        insurance coverage is included in investigative and data 
        sharing programs, to the maximum extent feasible, with adequate 
        protection provided for law enforcement-related data that is 
        sensitive because of concerns for the identities of criminal 
        subjects or targets, and that recognizes that private coverage 
        may be responsible for fraud, waste, and abuse of public and 
        policyholder funds;
            ``(4) not later than 12 months after the date of enactment 
        of this section, develop and issue guidelines for purposes of 
        carrying out the strategic plan under paragraph (1), 
        recognizing that fraudulent activity in the health care system 
        can affect both public and private sector health insurance 
        coverage, and that the prevention, detection, investigation, 
        and prosecution of fraud against private health insurance 
        coverage is integral to the overall effort to combat health 
        care fraud;
            ``(5) at least once during every 5-year period, update the 
        strategic plan issued pursuant to paragraph (1) and the 
        guidelines issued pursuant to paragraph (4);
            ``(6) develop recommendations, in consultation with the 
        Office of Management and Budget, for measures to estimate the 
        amount of fraud, waste, and abuse in connection with public and 
        private health insurance coverage, and the annual savings 
        resulting from specific program integrity measures;
            ``(7) identify improvements needed for purposes of 
        information-sharing systems and activities used in implementing 
        the strategic plan under paragraph (1); and
            ``(8) establish a consultative panel composed of 
        representatives of the private sector health insurance industry 
        and consult with this panel in the formulation of Council 
        recommendations.
    ``(d) Exemptions.--The Council shall be exempt from--
            ``(1) sections 553, 556, and 557 of title 5, United States 
        Code, in the issuance of guidelines pursuant to subsection 
        (c)(4); and
            ``(2) the Federal Advisory Committee Act (5 U.S.C. app.) in 
        order to protect against the release of information which might 
        undermine Federal, State, or local health care fraud control 
        efforts.
    ``(e) Public Participation.--The Council shall provide for 
reasonable public participation in matters before the Council to the 
extent that such participation would not compromise the Council's, or 
any other Federal, State, or local government entity's, efforts to 
control health care fraud and abuse.''.

            Subtitle C--False Statements and Representations

SEC. 521. PROHIBITION ON FALSE STATEMENTS AND REPRESENTATIONS.

    (a) Prohibition.--Part 5 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.) is 
amended by adding at the end the following:

``SEC. 519. PROHIBITION ON FALSE STATEMENTS AND REPRESENTATIONS.

    ``No person, in connection with a plan or other arrangement that is 
multiple employer welfare arrangement described in section 3(40), shall 
make a false statement or false representation of fact, knowing it to 
be false, in connection with the marketing or sale of such plan or 
arrangement, to any employee, any member of an employee organization, 
any beneficiary, any employer, any employee organization, the 
Secretary, or any State, or the representative or agent of any such 
person, State, or the Secretary, concerning--
            ``(1) the financial condition or solvency of such plan or 
        arrangement;
            ``(2) the benefits provided by such plan or arrangement;
            ``(3) the regulatory status of such plan or other 
        arrangement under any Federal or State law governing collective 
        bargaining, labor management relations, or intern union 
        affairs; or
            ``(4) the regulatory status of such plan or other 
        arrangement regarding exemption from state regulatory authority 
        under this Act.
This section shall not apply to any plan or arrangement that does not 
fall within the meaning of the term `multiple employer welfare 
arrangement' under section 3(40(A).''.
    (b) Criminal Penalties.--Section 501 of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1131) is amended--
            (1) by inserting ``(a)'' before ``Any person''; and
            (2) by adding at the end the following:
    ``(b) Any person that violates section 519 shall upon conviction be 
imprisoned not more than 10 years or fined under title 18, United 
States Code, or both.''.
    (c) Conforming Amendment.--The table of sections for part 5 of 
subtitle B of title I of the Employee Retirement Income Security Act of 
1974 is amended by adding at the end the following:

``Sec. 519. Prohibition on false statement and representations.''.

                Subtitle D--Federal Health Care Offense

SEC. 531. CLARIFYING DEFINITION.

    Section 24(a)(2) of title 18, United States Code, is amended by 
inserting ``or section 411, 518, or 511 of the Employee Retirement 
Income Security Act of 1974,'' after ``1954 of this title''.

          Subtitle E--Uniformity in Fraud and Abuse Reporting

SEC. 541. DEVELOPMENT OF MODEL UNIFORM REPORT FORM.

    Part C of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-91 et seq.), as amended by section 511, is further amended by 
inserting after section 2794, the following:

``SEC. 2795. UNIFORM FRAUD AND ABUSE REFERRAL FORMAT.

    ``The Secretary shall request the National Association of Insurance 
Commissioners to develop a model uniform report form for private health 
insurance issuer seeking to refer suspected fraud and abuse to State 
insurance departments or other responsible State agencies for 
investigation. The Secretary shall request that the National 
Association of Insurance Commissioners develop recommendations for 
uniform reporting standards for such referrals.''.

    Subtitle F--Applicability of State Law to Combat Fraud and Abuse

SEC. 551. APPLICABILITY OF STATE LAW TO COMBAT FRAUD AND ABUSE.

    (a) In General.--Part 5 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.), as 
amended by section 521, is further amended by adding at the end the 
following:

``SEC. 520. APPLICABILITY OF STATE LAW TO COMBAT FRAUD AND ABUSE.

    ``The Secretary may, for the purpose of identifying, preventing, or 
prosecuting fraud and abuse, adopt regulatory standards establishing, 
or issue an order relating to a specific person establishing, that a 
person engaged in the business of providing insurance through a 
multiple employer welfare arrangement described in section 3(40) is 
subject to the laws of the States in which such person operates which 
regulate insurance in such State, notwithstanding section 514(b)(6) of 
this Act or the Liability Risk Retention Act of 1986, and regardless of 
whether the law of the State is otherwise preempted under any of such 
provisions. This section shall not apply to any plan or arrangement 
that does not fall within the meaning of the term `multiple employer 
welfare arrangement' under section 3(40(A).''.
    (b) Conforming Amendment.--The table of sections for part 5 of 
subtitle B of title I of the Employee Retirement Income Security Act of 
1974, as amended by section 521, is further amended by adding at the 
end the following:

``Sec. 520. Applicability of State law to combat fraud and abuse.''.

 Subtitle G--Enabling the Department of Labor to Issue Administrative 
  Summary Cease and Desist Orders and Summary Seizures Orders Against 
           Plans That Are in Financially Hazardous Condition

SEC. 561. ENABLING THE DEPARTMENT OF LABOR TO ISSUE ADMINISTRATIVE 
              SUMMARY CEASE AND DESIST ORDERS AND SUMMARY SEIZURES 
              ORDERS AGAINST PLANS THAT ARE IN FINANCIALLY HAZARDOUS 
              CONDITION.

    (a) In General.--Part 5 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.), as 
amended by section 551, is further amended by adding at the end the 
following:

``SEC. 521. ADMINISTRATIVE SUMMARY CEASE AND DESIST ORDERS AND SUMMARY 
              SEIZURE ORDERS AGAINST MULTIPLE EMPLOYER WELFARE 
              ARRANGEMENTS IN FINANCIALLY HAZARDOUS CONDITION.

    ``(a) In General.--The Secretary may issue a cease and desist (ex 
parte) order under this title if it appears to the Secretary that the 
alleged conduct of a multiple employer welfare arrangement described in 
section 3(40), other than a plan or arrangement described in subsection 
(g), is fraudulent, or creates an immediate danger to the public safety 
or welfare, or is causing or can be reasonably expected to cause 
significant, imminent, and irreparable public injury.
    ``(b) Hearing.--A person that is adversely affected by the issuance 
of a cease and desist order under subsection (a) may request a hearing 
by the Secretary regarding such order. The Secretary may require that a 
proceeding under this section, including all related information and 
evidence, be conducted in a confidential manner.
    ``(c) Burden of Proof.--The burden of proof in any hearing 
conducted under subsection (b) shall be on the party requesting the 
hearing to show cause why the cease and desist order should be set 
aside.
    ``(d) Determination.--Based upon the evidence presented at a 
hearing under subsection (b), the cease and desist order involved may 
be affirmed, modified, or set aside by the Secretary in whole or in 
part.
    ``(e) Seizure.--The Secretary may issue a summary seizure order 
under this title if it appears that a multiple employer welfare 
arrangement is in a financially hazardous condition.
    ``(f) Regulations.--The Secretary may promulgate such regulations 
or other guidance as may be necessary or appropriate to carry out this 
section.
    ``(g) Exception.--This section shall not apply to any plan or 
arrangement that does not fall within the meaning of the term `multiple 
employer welfare arrangement' under section 3(40(A).''.
    (b) Conforming Amendment.--The table of sections for part 5 of 
subtitle B of title I of the Employee Retirement Income Security Act of 
1974, as amended by section 551, is further amended by adding at the 
end the following:

``Sec. 521. Administrative summary cease and desist orders and summary 
                            seizure orders against health plans in 
                            financially hazardous condition.''.

  Subtitle H--Requiring Multiple Employer Welfare Arrangement (MEWA) 
Plans to File a Registration Form With the Department of Labor Prior to 
                      Enrolling Anyone in the Plan

SEC. 571. MEWA PLAN REGISTRATION WITH DEPARTMENT OF LABOR.

    Section 101(g) of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1021(g)) is amended--
            (1) by striking ``Secretary may'' and inserting ``Secretary 
        shall''; and
            (2) by inserting ``to register with the Secretary prior to 
        operating in a State and may, by regulation, require such 
        multiple employer welfare arrangements'' after ``not group 
        health plans''.

     Subtitle I--Permitting Evidentiary Privilege and Confidential 
                             Communications

SEC. 581. PERMITTING EVIDENTIARY PRIVILEGE AND CONFIDENTIAL 
              COMMUNICATIONS.

    Section 504 of the Employee Retirement Income Security Act of 1974 
(29 U.S.C. 1134) is amended by adding at the end the following:
    ``(d) The Secretary may promulgate a regulation that provides an 
evidentiary privilege for, and provides for the confidentiality of 
communications between or among, any of the following entities or their 
agents, consultants, or employees:
            ``(1) A State insurance department.
            ``(2) A State attorney general.
            ``(3) The National Association of Insurance Commissioners.
            ``(4) The Department of Labor.
            ``(5) The Department of the Treasury.
            ``(6) The Department of Justice.
            ``(7) The Department of Health and Human Services.
            ``(8) Any other Federal or State authority that the 
        Secretary determines is appropriate for the purposes of 
        enforcing the provisions of this title.
    ``(e) The privilege established under subsection (d) shall apply to 
communications related to any investigation, audit, examination, or 
inquiry conducted or coordinated by any of the agencies. A 
communication that is privileged under subsection (d) shall not waive 
any privilege otherwise available to the communicating agency or to any 
person who provided the information that is communicated.''.

       TITLE VI--IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES

         Subtitle A--Biologics Price Competition and Innovation

SEC. 601. SHORT TITLE.

    (a) In General.--This subtitle may be cited as the ``Biologics 
Price Competition and Innovation Act of 2009''.
    (b) Sense of the Senate.--It is the sense of the Senate that a 
biosimilars pathway balancing innovation and consumer interests should 
be established.

SEC. 602. APPROVAL PATHWAY FOR BIOSIMILAR BIOLOGICAL PRODUCTS.

    (a) Licensure of Biological Products as Biosimilar or 
Interchangeable.--Section 351 of the Public Health Service Act (42 
U.S.C. 262) is amended--
            (1) in subsection (a)(1)(A), by inserting ``under this 
        subsection or subsection (k)'' after ``biologics license''; and
            (2) by adding at the end the following:
    ``(k) Licensure of Biological Products as Biosimilar or 
Interchangeable.--
            ``(1) In general.--Any person may submit an application for 
        licensure of a biological product under this subsection.
            ``(2) Content.--
                    ``(A) In general.--
                            ``(i) Required information.--An application 
                        submitted under this subsection shall include 
                        information demonstrating that--
                                    ``(I) the biological product is 
                                biosimilar to a reference product based 
                                upon data derived from--
                                            ``(aa) analytical studies 
                                        that demonstrate that the 
                                        biological product is highly 
                                        similar to the reference 
                                        product notwithstanding minor 
                                        differences in clinically 
                                        inactive components;
                                            ``(bb) animal studies 
                                        (including the assessment of 
                                        toxicity); and
                                            ``(cc) a clinical study or 
                                        studies (including the 
                                        assessment of immunogenicity 
                                        and pharmacokinetics or 
                                        pharmacodynamics) that are 
                                        sufficient to demonstrate 
                                        safety, purity, and potency in 
                                        1 or more appropriate 
                                        conditions of use for which the 
                                        reference product is licensed 
                                        and intended to be used and for 
                                        which licensure is sought for 
                                        the biological product;
                                    ``(II) the biological product and 
                                reference product utilize the same 
                                mechanism or mechanisms of action for 
                                the condition or conditions of use 
                                prescribed, recommended, or suggested 
                                in the proposed labeling, but only to 
                                the extent the mechanism or mechanisms 
                                of action are known for the reference 
                                product;
                                    ``(III) the condition or conditions 
                                of use prescribed, recommended, or 
                                suggested in the labeling proposed for 
                                the biological product have been 
                                previously approved for the reference 
                                product;
                                    ``(IV) the route of administration, 
                                the dosage form, and the strength of 
                                the biological product are the same as 
                                those of the reference product; and
                                    ``(V) the facility in which the 
                                biological product is manufactured, 
                                processed, packed, or held meets 
                                standards designed to assure that the 
                                biological product continues to be 
                                safe, pure, and potent.
                            ``(ii) Determination by secretary.--The 
                        Secretary may determine, in the Secretary's 
                        discretion, that an element described in clause 
                        (i)(I) is unnecessary in an application 
                        submitted under this subsection.
                            ``(iii) Additional information.--An 
                        application submitted under this subsection--
                                    ``(I) shall include publicly-
                                available information regarding the 
                                Secretary's previous determination that 
                                the reference product is safe, pure, 
                                and potent; and
                                    ``(II) may include any additional 
                                information in support of the 
                                application, including publicly-
                                available information with respect to 
                                the reference product or another 
                                biological product.
                    ``(B) Interchangeability.--An application (or a 
                supplement to an application) submitted under this 
                subsection may include information demonstrating that 
                the biological product meets the standards described in 
                paragraph (4).
            ``(3) Evaluation by secretary.--Upon review of an 
        application (or a supplement to an application) submitted under 
        this subsection, the Secretary shall license the biological 
        product under this subsection if--
                    ``(A) the Secretary determines that the information 
                submitted in the application (or the supplement) is 
                sufficient to show that the biological product--
                            ``(i) is biosimilar to the reference 
                        product; or
                            ``(ii) meets the standards described in 
                        paragraph (4), and therefore is interchangeable 
                        with the reference product; and
                    ``(B) the applicant (or other appropriate person) 
                consents to the inspection of the facility that is the 
                subject of the application, in accordance with 
                subsection (c).
            ``(4) Safety standards for determining 
        interchangeability.--Upon review of an application submitted 
        under this subsection or any supplement to such application, 
        the Secretary shall determine the biological product to be 
        interchangeable with the reference product if the Secretary 
        determines that the information submitted in the application 
        (or a supplement to such application) is sufficient to show 
        that--
                    ``(A) the biological product--
                            ``(i) is biosimilar to the reference 
                        product; and
                            ``(ii) can be expected to produce the same 
                        clinical result as the reference product in any 
                        given patient; and
                    ``(B) for a biological product that is administered 
                more than once to an individual, the risk in terms of 
                safety or diminished efficacy of alternating or 
                switching between use of the biological product and the 
                reference product is not greater than the risk of using 
                the reference product without such alternation or 
                switch.
            ``(5) General rules.--
                    ``(A) One reference product per application.--A 
                biological product, in an application submitted under 
                this subsection, may not be evaluated against more than 
                1 reference product.
                    ``(B) Review.--An application submitted under this 
                subsection shall be reviewed by the division within the 
                Food and Drug Administration that is responsible for 
                the review and approval of the application under which 
                the reference product is licensed.
                    ``(C) Risk evaluation and mitigation strategies.--
                The authority of the Secretary with respect to risk 
                evaluation and mitigation strategies under the Federal 
                Food, Drug, and Cosmetic Act shall apply to biological 
                products licensed under this subsection in the same 
                manner as such authority applies to biological products 
                licensed under subsection (a).
            ``(6) Exclusivity for first interchangeable biological 
        product.--Upon review of an application submitted under this 
        subsection relying on the same reference product for which a 
        prior biological product has received a determination of 
        interchangeability for any condition of use, the Secretary 
        shall not make a determination under paragraph (4) that the 
        second or subsequent biological product is interchangeable for 
        any condition of use until the earlier of--
                    ``(A) 1 year after the first commercial marketing 
                of the first interchangeable biosimilar biological 
                product to be approved as interchangeable for that 
                reference product;
                    ``(B) 18 months after--
                            ``(i) a final court decision on all patents 
                        in suit in an action instituted under 
                        subsection (l)(6) against the applicant that 
                        submitted the application for the first 
                        approved interchangeable biosimilar biological 
                        product; or
                            ``(ii) the dismissal with or without 
                        prejudice of an action instituted under 
                        subsection (l)(6) against the applicant that 
                        submitted the application for the first 
                        approved interchangeable biosimilar biological 
                        product; or
                    ``(C)(i) 42 months after approval of the first 
                interchangeable biosimilar biological product if the 
                applicant that submitted such application has been sued 
                under subsection (l)(6) and such litigation is still 
                ongoing within such 42-month period; or
                    ``(ii) 18 months after approval of the first 
                interchangeable biosimilar biological product if the 
                applicant that submitted such application has not been 
                sued under subsection (l)(6).
        For purposes of this paragraph, the term `final court decision' 
        means a final decision of a court from which no appeal (other 
        than a petition to the United States Supreme Court for a writ 
        of certiorari) has been or can be taken.
            ``(7) Exclusivity for reference product.--
                    ``(A) Effective date of biosimilar application 
                approval.--Approval of an application under this 
                subsection may not be made effective by the Secretary 
                until the date that is 12 years after the date on which 
                the reference product was first licensed under 
                subsection (a).
                    ``(B) Filing period.--An application under this 
                subsection may not be submitted to the Secretary until 
                the date that is 4 years after the date on which the 
                reference product was first licensed under subsection 
                (a).
                    ``(C) First licensure.--Subparagraphs (A) and (B) 
                shall not apply to a license for or approval of--
                            ``(i) a supplement for the biological 
                        product that is the reference product; or
                            ``(ii) a subsequent application filed by 
                        the same sponsor or manufacturer of the 
                        biological product that is the reference 
                        product (or a licensor, predecessor in 
                        interest, or other related entity) for--
                                    ``(I) a change (not including a 
                                modification to the structure of the 
                                biological product) that results in a 
                                new indication, route of 
                                administration, dosing schedule, dosage 
                                form, delivery system, delivery device, 
                                or strength; or
                                    ``(II) a modification to the 
                                structure of the biological product 
                                that does not result in a change in 
                                safety, purity, or potency.
            ``(8) Guidance documents.--
                    ``(A) In general.--The Secretary may, after 
                opportunity for public comment, issue guidance in 
                accordance, except as provided in subparagraph (B)(i), 
                with section 701(h) of the Federal Food, Drug, and 
                Cosmetic Act with respect to the licensure of a 
                biological product under this subsection. Any such 
                guidance may be general or specific.
                    ``(B) Public comment.--
                            ``(i) In general.--The Secretary shall 
                        provide the public an opportunity to comment on 
                        any proposed guidance issued under subparagraph 
                        (A) before issuing final guidance.
                            ``(ii) Input regarding most valuable 
                        guidance.--The Secretary shall establish a 
                        process through which the public may provide 
                        the Secretary with input regarding priorities 
                        for issuing guidance.
                    ``(C) No requirement for application 
                consideration.--The issuance (or non-issuance) of 
                guidance under subparagraph (A) shall not preclude the 
                review of, or action on, an application submitted under 
                this subsection.
                    ``(D) Requirement for product class-specific 
                guidance.--If the Secretary issues product class-
                specific guidance under subparagraph (A), such guidance 
                shall include a description of--
                            ``(i) the criteria that the Secretary will 
                        use to determine whether a biological product 
                        is highly similar to a reference product in 
                        such product class; and
                            ``(ii) the criteria, if available, that the 
                        Secretary will use to determine whether a 
                        biological product meets the standards 
                        described in paragraph (4).
                    ``(E) Certain product classes.--
                            ``(i) Guidance.--The Secretary may indicate 
                        in a guidance document that the science and 
                        experience, as of the date of such guidance, 
                        with respect to a product or product class (not 
                        including any recombinant protein) does not 
                        allow approval of an application for a license 
                        as provided under this subsection for such 
                        product or product class.
                            ``(ii) Modification or reversal.--The 
                        Secretary may issue a subsequent guidance 
                        document under subparagraph (A) to modify or 
                        reverse a guidance document under clause (i).
                            ``(iii) No effect on ability to deny 
                        license.--Clause (i) shall not be construed to 
                        require the Secretary to approve a product with 
                        respect to which the Secretary has not 
                        indicated in a guidance document that the 
                        science and experience, as described in clause 
                        (i), does not allow approval of such an 
                        application.
    ``(l) Patents.--
            ``(1) Confidential access to subsection (k) application.--
                    ``(A) Application of paragraph.--Unless otherwise 
                agreed to by a person that submits an application under 
                subsection (k) (referred to in this subsection as the 
                `subsection (k) applicant') and the sponsor of the 
                application for the reference product (referred to in 
                this subsection as the `reference product sponsor'), 
                the provisions of this paragraph shall apply to the 
                exchange of information described in this subsection.
                    ``(B) In general.--
                            ``(i) Provision of confidential 
                        information.--When a subsection (k) applicant 
                        submits an application under subsection (k), 
                        such applicant shall provide to the persons 
                        described in clause (ii), subject to the terms 
                        of this paragraph, confidential access to the 
                        information required to be produced pursuant to 
                        paragraph (2) and any other information that 
                        the subsection (k) applicant determines, in its 
                        sole discretion, to be appropriate (referred to 
                        in this subsection as the `confidential 
                        information').
                            ``(ii) Recipients of information.--The 
                        persons described in this clause are the 
                        following:
                                    ``(I) Outside counsel.--One or more 
                                attorneys designated by the reference 
                                product sponsor who are employees of an 
                                entity other than the reference product 
                                sponsor (referred to in this paragraph 
                                as the `outside counsel'), provided 
                                that such attorneys do not engage, 
                                formally or informally, in patent 
                                prosecution relevant or related to the 
                                reference product.
                                    ``(II) In-house counsel.--One 
                                attorney that represents the reference 
                                product sponsor who is an employee of 
                                the reference product sponsor, provided 
                                that such attorney does not engage, 
                                formally or informally, in patent 
                                prosecution relevant or related to the 
                                reference product.
                            ``(iii) Patent owner access.--A 
                        representative of the owner of a patent 
                        exclusively licensed to a reference product 
                        sponsor with respect to the reference product 
                        and who has retained a right to assert the 
                        patent or participate in litigation concerning 
                        the patent may be provided the confidential 
                        information, provided that the representative 
                        informs the reference product sponsor and the 
                        subsection (k) applicant of his or her 
                        agreement to be subject to the confidentiality 
                        provisions set forth in this paragraph, 
                        including those under clause (ii).
                    ``(C) Limitation on disclosure.--No person that 
                receives confidential information pursuant to 
                subparagraph (B) shall disclose any confidential 
                information to any other person or entity, including 
                the reference product sponsor employees, outside 
                scientific consultants, or other outside counsel 
                retained by the reference product sponsor, without the 
                prior written consent of the subsection (k) applicant, 
                which shall not be unreasonably withheld.
                    ``(D) Use of confidential information.--
                Confidential information shall be used for the sole and 
                exclusive purpose of determining, with respect to each 
                patent assigned to or exclusively licensed by the 
                reference product sponsor, whether a claim of patent 
                infringement could reasonably be asserted if the 
                subsection (k) applicant engaged in the manufacture, 
                use, offering for sale, sale, or importation into the 
                United States of the biological product that is the 
                subject of the application under subsection (k).
                    ``(E) Ownership of confidential information.--The 
                confidential information disclosed under this paragraph 
                is, and shall remain, the property of the subsection 
                (k) applicant. By providing the confidential 
                information pursuant to this paragraph, the subsection 
                (k) applicant does not provide the reference product 
                sponsor or the outside counsel any interest in or 
                license to use the confidential information, for 
                purposes other than those specified in subparagraph 
                (D).
                    ``(F) Effect of infringement action.--In the event 
                that the reference product sponsor files a patent 
                infringement suit, the use of confidential information 
                shall continue to be governed by the terms of this 
                paragraph until such time as a court enters a 
                protective order regarding the information. Upon entry 
                of such order, the subsection (k) applicant may 
                redesignate confidential information in accordance with 
                the terms of that order. No confidential information 
                shall be included in any publicly-available complaint 
                or other pleading. In the event that the reference 
                product sponsor does not file an infringement action by 
                the date specified in paragraph (6), the reference 
                product sponsor shall return or destroy all 
                confidential information received under this paragraph, 
                provided that if the reference product sponsor opts to 
                destroy such information, it will confirm destruction 
                in writing to the subsection (k) applicant.
                    ``(G) Rule of construction.--Nothing in this 
                paragraph shall be construed--
                            ``(i) as an admission by the subsection (k) 
                        applicant regarding the validity, 
                        enforceability, or infringement of any patent; 
                        or
                            ``(ii) as an agreement or admission by the 
                        subsection (k) applicant with respect to the 
                        competency, relevance, or materiality of any 
                        confidential information.
                    ``(H) Effect of violation.--The disclosure of any 
                confidential information in violation of this paragraph 
                shall be deemed to cause the subsection (k) applicant 
                to suffer irreparable harm for which there is no 
                adequate legal remedy and the court shall consider 
                immediate injunctive relief to be an appropriate and 
                necessary remedy for any violation or threatened 
                violation of this paragraph.
            ``(2) Subsection (k) application information.--Not later 
        than 20 days after the Secretary notifies the subsection (k) 
        applicant that the application has been accepted for review, 
        the subsection (k) applicant--
                    ``(A) shall provide to the reference product 
                sponsor a copy of the application submitted to the 
                Secretary under subsection (k), and such other 
                information that describes the process or processes 
                used to manufacture the biological product that is the 
                subject of such application; and
                    ``(B) may provide to the reference product sponsor 
                additional information requested by or on behalf of the 
                reference product sponsor.
            ``(3) List and description of patents.--
                    ``(A) List by reference product sponsor.--Not later 
                than 60 days after the receipt of the application and 
                information under paragraph (2), the reference product 
                sponsor shall provide to the subsection (k) applicant--
                            ``(i) a list of patents for which the 
                        reference product sponsor believes a claim of 
                        patent infringement could reasonably be 
                        asserted by the reference product sponsor, or 
                        by a patent owner that has granted an exclusive 
                        license to the reference product sponsor with 
                        respect to the reference product, if a person 
                        not licensed by the reference product sponsor 
                        engaged in the making, using, offering to sell, 
                        selling, or importing into the United States of 
                        the biological product that is the subject of 
                        the subsection (k) application; and
                            ``(ii) an identification of the patents on 
                        such list that the reference product sponsor 
                        would be prepared to license to the subsection 
                        (k) applicant.
                    ``(B) List and description by subsection (k) 
                applicant.--Not later than 60 days after receipt of the 
                list under subparagraph (A), the subsection (k) 
                applicant--
                            ``(i) may provide to the reference product 
                        sponsor a list of patents to which the 
                        subsection (k) applicant believes a claim of 
                        patent infringement could reasonably be 
                        asserted by the reference product sponsor if a 
                        person not licensed by the reference product 
                        sponsor engaged in the making, using, offering 
                        to sell, selling, or importing into the United 
                        States of the biological product that is the 
                        subject of the subsection (k) application;
                            ``(ii) shall provide to the reference 
                        product sponsor, with respect to each patent 
                        listed by the reference product sponsor under 
                        subparagraph (A) or listed by the subsection 
                        (k) applicant under clause (i)--
                                    ``(I) a detailed statement that 
                                describes, on a claim by claim basis, 
                                the factual and legal basis of the 
                                opinion of the subsection (k) applicant 
                                that such patent is invalid, 
                                unenforceable, or will not be infringed 
                                by the commercial marketing of the 
                                biological product that is the subject 
                                of the subsection (k) application; or
                                    ``(II) a statement that the 
                                subsection (k) applicant does not 
                                intend to begin commercial marketing of 
                                the biological product before the date 
                                that such patent expires; and
                            ``(iii) shall provide to the reference 
                        product sponsor a response regarding each 
                        patent identified by the reference product 
                        sponsor under subparagraph (A)(ii).
                    ``(C) Description by reference product sponsor.--
                Not later than 60 days after receipt of the list and 
                statement under subparagraph (B), the reference product 
                sponsor shall provide to the subsection (k) applicant a 
                detailed statement that describes, with respect to each 
                patent described in subparagraph (B)(ii)(I), on a claim 
                by claim basis, the factual and legal basis of the 
                opinion of the reference product sponsor that such 
                patent will be infringed by the commercial marketing of 
                the biological product that is the subject of the 
                subsection (k) application and a response to the 
                statement concerning validity and enforceability 
                provided under subparagraph (B)(ii)(I).
            ``(4) Patent resolution negotiations.--
                    ``(A) In general.--After receipt by the subsection 
                (k) applicant of the statement under paragraph (3)(C), 
                the reference product sponsor and the subsection (k) 
                applicant shall engage in good faith negotiations to 
                agree on which, if any, patents listed under paragraph 
                (3) by the subsection (k) applicant or the reference 
                product sponsor shall be the subject of an action for 
                patent infringement under paragraph (6).
                    ``(B) Failure to reach agreement.--If, within 15 
                days of beginning negotiations under subparagraph (A), 
                the subsection (k) applicant and the reference product 
                sponsor fail to agree on a final and complete list of 
                which, if any, patents listed under paragraph (3) by 
                the subsection (k) applicant or the reference product 
                sponsor shall be the subject of an action for patent 
                infringement under paragraph (6), the provisions of 
                paragraph (5) shall apply to the parties.
            ``(5) Patent resolution if no agreement.--
                    ``(A) Number of patents.--The subsection (k) 
                applicant shall notify the reference product sponsor of 
                the number of patents that such applicant will provide 
                to the reference product sponsor under subparagraph 
                (B)(i)(I).
                    ``(B) Exchange of patent lists.--
                            ``(i) In general.--On a date agreed to by 
                        the subsection (k) applicant and the reference 
                        product sponsor, but in no case later than 5 
                        days after the subsection (k) applicant 
                        notifies the reference product sponsor under 
                        subparagraph (A), the subsection (k) applicant 
                        and the reference product sponsor shall 
                        simultaneously exchange--
                                    ``(I) the list of patents that the 
                                subsection (k) applicant believes 
                                should be the subject of an action for 
                                patent infringement under paragraph 
                                (6); and
                                    ``(II) the list of patents, in 
                                accordance with clause (ii), that the 
                                reference product sponsor believes 
                                should be the subject of an action for 
                                patent infringement under paragraph 
                                (6).
                            ``(ii) Number of patents listed by 
                        reference product sponsor.--
                                    ``(I) In general.--Subject to 
                                subclause (II), the number of patents 
                                listed by the reference product sponsor 
                                under clause (i)(II) may not exceed the 
                                number of patents listed by the 
                                subsection (k) applicant under clause 
                                (i)(I).
                                    ``(II) Exception.--If a subsection 
                                (k) applicant does not list any patent 
                                under clause (i)(I), the reference 
                                product sponsor may list 1 patent under 
                                clause (i)(II).
            ``(6) Immediate patent infringement action.--
                    ``(A) Action if agreement on patent list.--If the 
                subsection (k) applicant and the reference product 
                sponsor agree on patents as described in paragraph (4), 
                not later than 30 days after such agreement, the 
                reference product sponsor shall bring an action for 
                patent infringement with respect to each such patent.
                    ``(B) Action if no agreement on patent list.--If 
                the provisions of paragraph (5) apply to the parties as 
                described in paragraph (4)(B), not later than 30 days 
                after the exchange of lists under paragraph (5)(B), the 
                reference product sponsor shall bring an action for 
                patent infringement with respect to each patent that is 
                included on such lists.
                    ``(C) Notification and publication of complaint.--
                            ``(i) Notification to secretary.--Not later 
                        than 30 days after a complaint is served to a 
                        subsection (k) applicant in an action for 
                        patent infringement described under this 
                        paragraph, the subsection (k) applicant shall 
                        provide the Secretary with notice and a copy of 
                        such complaint.
                            ``(ii) Publication by secretary.--The 
                        Secretary shall publish in the Federal Register 
                        notice of a complaint received under clause 
                        (i).
            ``(7) Newly issued or licensed patents.--In the case of a 
        patent that--
                    ``(A) is issued to, or exclusively licensed by, the 
                reference product sponsor after the date that the 
                reference product sponsor provided the list to the 
                subsection (k) applicant under paragraph (3)(A); and
                    ``(B) the reference product sponsor reasonably 
                believes that, due to the issuance of such patent, a 
                claim of patent infringement could reasonably be 
                asserted by the reference product sponsor if a person 
                not licensed by the reference product sponsor engaged 
                in the making, using, offering to sell, selling, or 
                importing into the United States of the biological 
                product that is the subject of the subsection (k) 
                application,
        not later than 30 days after such issuance or licensing, the 
        reference product sponsor shall provide to the subsection (k) 
        applicant a supplement to the list provided by the reference 
        product sponsor under paragraph (3)(A) that includes such 
        patent, not later than 30 days after such supplement is 
        provided, the subsection (k) applicant shall provide a 
        statement to the reference product sponsor in accordance with 
        paragraph (3)(B), and such patent shall be subject to paragraph 
        (8).
            ``(8) Notice of commercial marketing and preliminary 
        injunction.--
                    ``(A) Notice of commercial marketing.--The 
                subsection (k) applicant shall provide notice to the 
                reference product sponsor not later than 180 days 
                before the date of the first commercial marketing of 
                the biological product licensed under subsection (k).
                    ``(B) Preliminary injunction.--After receiving the 
                notice under subparagraph (A) and before such date of 
                the first commercial marketing of such biological 
                product, the reference product sponsor may seek a 
                preliminary injunction prohibiting the subsection (k) 
                applicant from engaging in the commercial manufacture 
                or sale of such biological product until the court 
                decides the issue of patent validity, enforcement, and 
                infringement with respect to any patent that is--
                            ``(i) included in the list provided by the 
                        reference product sponsor under paragraph 
                        (3)(A) or in the list provided by the 
                        subsection (k) applicant under paragraph 
                        (3)(B); and
                            ``(ii) not included, as applicable, on--
                                    ``(I) the list of patents described 
                                in paragraph (4); or
                                    ``(II) the lists of patents 
                                described in paragraph (5)(B).
                    ``(C) Reasonable cooperation.--If the reference 
                product sponsor has sought a preliminary injunction 
                under subparagraph (B), the reference product sponsor 
                and the subsection (k) applicant shall reasonably 
                cooperate to expedite such further discovery as is 
                needed in connection with the preliminary injunction 
                motion.
            ``(9) Limitation on declaratory judgment action.--
                    ``(A) Subsection (k) application provided.--If a 
                subsection (k) applicant provides the application and 
                information required under paragraph (2)(A), neither 
                the reference product sponsor nor the subsection (k) 
                applicant may, prior to the date notice is received 
                under paragraph (8)(A), bring any action under section 
                2201 of title 28, United States Code, for a declaration 
                of infringement, validity, or enforceability of any 
                patent that is described in clauses (i) and (ii) of 
                paragraph (8)(B).
                    ``(B) Subsequent failure to act by subsection (k) 
                applicant.--If a subsection (k) applicant fails to 
                complete an action required of the subsection (k) 
                applicant under paragraph (3)(B)(ii), paragraph (5), 
                paragraph (6)(C)(i), paragraph (7), or paragraph 
                (8)(A), the reference product sponsor, but not the 
                subsection (k) applicant, may bring an action under 
                section 2201 of title 28, United States Code, for a 
                declaration of infringement, validity, or 
                enforceability of any patent included in the list 
                described in paragraph (3)(A), including as provided 
                under paragraph (7).
                    ``(C) Subsection (k) application not provided.--If 
                a subsection (k) applicant fails to provide the 
                application and information required under paragraph 
                (2)(A), the reference product sponsor, but not the 
                subsection (k) applicant, may bring an action under 
                section 2201 of title 28, United States Code, for a 
                declaration of infringement, validity, or 
                enforceability of any patent that claims the biological 
                product or a use of the biological product.''.
    (b) Definitions.--Section 351(i) of the Public Health Service Act 
(42 U.S.C. 262(i)) is amended--
            (1) by striking ``In this section, the term `biological 
        product' means'' and inserting the following: ``In this 
        section:
            ``(1) The term `biological product' means'';
            (2) in paragraph (1), as so designated, by inserting 
        ``protein (except any chemically synthesized polypeptide),'' 
        after ``allergenic product,''; and
            (3) by adding at the end the following:
            ``(2) The term `biosimilar' or `biosimilarity', in 
        reference to a biological product that is the subject of an 
        application under subsection (k), means--
                    ``(A) that the biological product is highly similar 
                to the reference product notwithstanding minor 
                differences in clinically inactive components; and
                    ``(B) there are no clinically meaningful 
                differences between the biological product and the 
                reference product in terms of the safety, purity, and 
                potency of the product.
            ``(3) The term `interchangeable' or `interchangeability', 
        in reference to a biological product that is shown to meet the 
        standards described in subsection (k)(4), means that the 
        biological product may be substituted for the reference product 
        without the intervention of the health care provider who 
        prescribed the reference product.
            ``(4) The term `reference product' means the single 
        biological product licensed under subsection (a) against which 
        a biological product is evaluated in an application submitted 
        under subsection (k).''.
    (c) Conforming Amendments Relating to Patents.--
            (1) Patents.--Section 271(e) of title 35, United States 
        Code, is amended--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A), by striking ``or'' 
                        at the end;
                            (ii) in subparagraph (B), by adding ``or'' 
                        at the end; and
                            (iii) by inserting after subparagraph (B) 
                        the following:
            ``(C)(i) with respect to a patent that is identified in the 
        list of patents described in section 351(l)(3) of the Public 
        Health Service Act (including as provided under section 
        351(l)(7) of such Act), an application seeking approval of a 
        biological product, or
            ``(ii) if the applicant for the application fails to 
        provide the application and information required under section 
        351(l)(2)(A) of such Act, an application seeking approval of a 
        biological product for a patent that could be identified 
        pursuant to section 351(l)(3)(A)(i) of such Act,''; and
                            (iv) in the matter following subparagraph 
                        (C) (as added by clause (iii)), by striking 
                        ``or veterinary biological product'' and 
                        inserting ``, veterinary biological product, or 
                        biological product'';
                    (B) in paragraph (4)--
                            (i) in subparagraph (B), by--
                                    (I) striking ``or veterinary 
                                biological product'' and inserting ``, 
                                veterinary biological product, or 
                                biological product''; and
                                    (II) striking ``and'' at the end;
                            (ii) in subparagraph (C), by--
                                    (I) striking ``or veterinary 
                                biological product'' and inserting ``, 
                                veterinary biological product, or 
                                biological product''; and
                                    (II) striking the period and 
                                inserting ``, and'';
                            (iii) by inserting after subparagraph (C) 
                        the following:
            ``(D) the court shall order a permanent injunction 
        prohibiting any infringement of the patent by the biological 
        product involved in the infringement until a date which is not 
        earlier than the date of the expiration of the patent that has 
        been infringed under paragraph (2)(C), provided the patent is 
        the subject of a final court decision, as defined in section 
        351(k)(6) of the Public Health Service Act, in an action for 
        infringement of the patent under section 351(l)(6) of such Act, 
        and the biological product has not yet been approved because of 
        section 351(k)(7) of such Act.''; and
                            (iv) in the matter following subparagraph 
                        (D) (as added by clause (iii)), by striking 
                        ``and (C)'' and inserting ``(C), and (D)''; and
                    (C) by adding at the end the following:
    ``(6)(A) Subparagraph (B) applies, in lieu of paragraph (4), in the 
case of a patent--
            ``(i) that is identified, as applicable, in the list of 
        patents described in section 351(l)(4) of the Public Health 
        Service Act or the lists of patents described in section 
        351(l)(5)(B) of such Act with respect to a biological product; 
        and
            ``(ii) for which an action for infringement of the patent 
        with respect to the biological product--
                    ``(I) was brought after the expiration of the 30-
                day period described in subparagraph (A) or (B), as 
                applicable, of section 351(l)(6) of such Act; or
                    ``(II) was brought before the expiration of the 30-
                day period described in subclause (I), but which was 
                dismissed without prejudice or was not prosecuted to 
                judgment in good faith.
    ``(B) In an action for infringement of a patent described in 
subparagraph (A), the sole and exclusive remedy that may be granted by 
a court, upon a finding that the making, using, offering to sell, 
selling, or importation into the United States of the biological 
product that is the subject of the action infringed the patent, shall 
be a reasonable royalty.
    ``(C) The owner of a patent that should have been included in the 
list described in section 351(l)(3)(A) of the Public Health Service 
Act, including as provided under section 351(l)(7) of such Act for a 
biological product, but was not timely included in such list, may not 
bring an action under this section for infringement of the patent with 
respect to the biological product.''.
            (2) Conforming amendment under title 28.--Section 2201(b) 
        of title 28, United States Code, is amended by inserting before 
        the period the following: ``, or section 351 of the Public 
        Health Service Act''.
    (d) Conforming Amendments Under the Federal Food, Drug, and 
Cosmetic Act.--
            (1) Content and review of applications.--Section 
        505(b)(5)(B) of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 355(b)(5)(B)) is amended by inserting before the period 
        at the end of the first sentence the following: ``or, with 
        respect to an applicant for approval of a biological product 
        under section 351(k) of the Public Health Service Act, any 
        necessary clinical study or studies''.
            (2) New active ingredient.--Section 505B of the Federal 
        Food, Drug, and Cosmetic Act (21 U.S.C. 355c) is amended by 
        adding at the end the following:
    ``(n) New Active Ingredient.--
            ``(1) Non-interchangeable biosimilar biological product.--A 
        biological product that is biosimilar to a reference product 
        under section 351 of the Public Health Service Act, and that 
        the Secretary has not determined to meet the standards 
        described in subsection (k)(4) of such section for 
        interchangeability with the reference product, shall be 
        considered to have a new active ingredient under this section.
            ``(2) Interchangeable biosimilar biological product.--A 
        biological product that is interchangeable with a reference 
        product under section 351 of the Public Health Service Act 
        shall not be considered to have a new active ingredient under 
        this section.''.
    (e) Products Previously Approved Under Section 505.--
            (1) Requirement to follow section 351.--Except as provided 
        in paragraph (2), an application for a biological product shall 
        be submitted under section 351 of the Public Health Service Act 
        (42 U.S.C. 262) (as amended by this Act).
            (2) Exception.--An application for a biological product may 
        be submitted under section 505 of the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 355) if--
                    (A) such biological product is in a product class 
                for which a biological product in such product class is 
                the subject of an application approved under such 
                section 505 not later than the date of enactment of 
                this Act; and
                    (B) such application--
                            (i) has been submitted to the Secretary of 
                        Health and Human Services (referred to in this 
                        subtitle as the ``Secretary'') before the date 
                        of enactment of this Act; or
                            (ii) is submitted to the Secretary not 
                        later than the date that is 10 years after the 
                        date of enactment of this Act.
            (3) Limitation.--Notwithstanding paragraph (2), an 
        application for a biological product may not be submitted under 
        section 505 of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 355) if there is another biological product approved 
        under subsection (a) of section 351 of the Public Health 
        Service Act that could be a reference product with respect to 
        such application (within the meaning of such section 351) if 
        such application were submitted under subsection (k) of such 
        section 351.
            (4) Deemed approved under section 351.--An approved 
        application for a biological product under section 505 of the 
        Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355) shall be 
        deemed to be a license for the biological product under such 
        section 351 on the date that is 10 years after the date of 
        enactment of this Act.
            (5) Definitions.--For purposes of this subsection, the term 
        ``biological product'' has the meaning given such term under 
        section 351 of the Public Health Service Act (42 U.S.C. 262) 
        (as amended by this Act).
    (f) Follow-on Biologics User Fees.--
            (1) Development of user fees for biosimilar biological 
        products.--
                    (A) In general.--Beginning not later than October 
                1, 2010, the Secretary shall develop recommendations to 
                present to Congress with respect to the goals, and 
                plans for meeting the goals, for the process for the 
                review of biosimilar biological product applications 
                submitted under section 351(k) of the Public Health 
                Service Act (as added by this Act) for the first 5 
                fiscal years after fiscal year 2012. In developing such 
                recommendations, the Secretary shall consult with--
                            (i) the Committee on Health, Education, 
                        Labor, and Pensions of the Senate;
                            (ii) the Committee on Energy and Commerce 
                        of the House of Representatives;
                            (iii) scientific and academic experts;
                            (iv) health care professionals;
                            (v) representatives of patient and consumer 
                        advocacy groups; and
                            (vi) the regulated industry.
                    (B) Public review of recommendations.--After 
                negotiations with the regulated industry, the Secretary 
                shall--
                            (i) present the recommendations developed 
                        under subparagraph (A) to the Congressional 
                        committees specified in such subparagraph;
                            (ii) publish such recommendations in the 
                        Federal Register;
                            (iii) provide for a period of 30 days for 
                        the public to provide written comments on such 
                        recommendations;
                            (iv) hold a meeting at which the public may 
                        present its views on such recommendations; and
                            (v) after consideration of such public 
                        views and comments, revise such recommendations 
                        as necessary.
                    (C) Transmittal of recommendations.--Not later than 
                January 15, 2012, the Secretary shall transmit to 
                Congress the revised recommendations under subparagraph 
                (B), a summary of the views and comments received under 
                such subparagraph, and any changes made to the 
                recommendations in response to such views and comments.
            (2) Establishment of user fee program.--It is the sense of 
        the Senate that, based on the recommendations transmitted to 
        Congress by the Secretary pursuant to paragraph (1)(C), 
        Congress should authorize a program, effective on October 1, 
        2012, for the collection of user fees relating to the 
        submission of biosimilar biological product applications under 
        section 351(k) of the Public Health Service Act (as added by 
        this Act).
            (3) Transitional provisions for user fees for biosimilar 
        biological products.--
                    (A) Application of the prescription drug user fee 
                provisions.--Section 735(1)(B) of the Federal Food, 
                Drug, and Cosmetic Act (21 U.S.C. 379g(1)(B)) is 
                amended by striking ``section 351'' and inserting 
                ``subsection (a) or (k) of section 351''.
                    (B) Evaluation of costs of reviewing biosimilar 
                biological product applications.--During the period 
                beginning on the date of enactment of this Act and 
                ending on October 1, 2010, the Secretary shall collect 
                and evaluate data regarding the costs of reviewing 
                applications for biological products submitted under 
                section 351(k) of the Public Health Service Act (as 
                added by this Act) during such period.
                    (C) Audit.--
                            (i) In general.--On the date that is 2 
                        years after first receiving a user fee 
                        applicable to an application for a biological 
                        product under section 351(k) of the Public 
                        Health Service Act (as added by this Act), and 
                        on a biennial basis thereafter until October 1, 
                        2013, the Secretary shall perform an audit of 
                        the costs of reviewing such applications under 
                        such section 351(k). Such an audit shall 
                        compare--
                                    (I) the costs of reviewing such 
                                applications under such section 351(k) 
                                to the amount of the user fee 
                                applicable to such applications; and
                                    (II)(aa) such ratio determined 
                                under subclause (I); to
                                    (bb) the ratio of the costs of 
                                reviewing applications for biological 
                                products under section 351(a) of such 
                                Act (as amended by this Act) to the 
                                amount of the user fee applicable to 
                                such applications under such section 
                                351(a).
                            (ii) Alteration of user fee.--If the audit 
                        performed under clause (i) indicates that the 
                        ratios compared under subclause (II) of such 
                        clause differ by more than 5 percent, then the 
                        Secretary shall alter the user fee applicable 
                        to applications submitted under such section 
                        351(k) to more appropriately account for the 
                        costs of reviewing such applications.
                            (iii) Accounting standards.--The Secretary 
                        shall perform an audit under clause (i) in 
                        conformance with the accounting principles, 
                        standards, and requirements prescribed by the 
                        Comptroller General of the United States under 
                        section 3511 of title 31, United State Code, to 
                        ensure the validity of any potential 
                        variability.
            (4) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection such sums as 
        may be necessary for each of fiscal years 2010 through 2012.
    (g) Allocation of Savings; Special Reserve Fund.--
            (1) Determination of savings.--The Secretary of the 
        Treasury, in consultation with the Secretary, shall for each 
        fiscal year determine the amount of the savings to the Federal 
        Government as a result of the enactment of this subtitle and 
        shall transfer such amount to the Fund established under 
        paragraph (2) pursuant to a relevant appropriations Act.
            (2) Special reserve fund.--
                    (A) In general.--There is established in the 
                Treasury of the United States a fund to be designated 
                as the ``Biological Product Savings Fund'' to be made 
                available to the Secretary without fiscal year 
                limitation.
                    (B) Use of fund.--The amounts made available to the 
                Secretary through the Fund under subparagraph (A) shall 
                be expended on activities authorized under the Public 
                Health Service Act.
            (3) Authorization of appropriations.--There is authorized 
        to be appropriated for each fiscal year to the Fund established 
        under paragraph (2), the amount of the savings determined for 
        such fiscal year under paragraph (1).
    (h) Government Accountability Office Study.--
            (1) In general.--Not later than 3 years after the date of 
        enactment of this Act, the Comptroller General of the United 
        States shall study and report to Congress regarding--
                    (A) the extent to which pediatric studies of 
                biological products are being required under the 
                Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et 
                seq.); and
                    (B) any pediatric needs not being met under 
                existing authority.
            (2) Content of study.--The study under paragraph (1) shall 
        review and assess--
                    (A) the extent to which pediatric studies of 
                biological products are required under subsections (a) 
                and (b) of section 505B of the Federal Food, Drug and 
                Cosmetic Act (21 U.S.C. 355c);
                    (B) the extent to which pediatric studies of 
                biological products are required as part of risk 
                evaluation and mitigation strategies under such Act;
                    (C) the number, importance, and prioritization of 
                any biological products that are not being tested for 
                pediatric use; and
                    (D) recommendations for ensuring pediatric testing 
                of products identified in subparagraph (C), including 
                the consideration of any incentives, such as those 
                provided under the Best Pharmaceuticals for Children 
                Act.
    (i) Orphan Products.--If a reference product, as defined in section 
351 of the Public Health Service Act (42 U.S.C. 262) (as amended by 
this Act) has been designated under section 526 of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 360bb) for a rare disease or 
condition, a biological product seeking approval for such disease or 
condition under subsection (k) of such section 351 as biosimilar to, or 
interchangeable with, such reference product may be licensed by the 
Secretary only after the expiration for such reference product of the 
later of--
            (1) the 7-year period described in section 527(a) of the 
        Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360cc(a)); and
            (2) the 12-year period described in subsection (k)(7) of 
        such section 351.

SEC. 603. SAVINGS.

    (a) Determination.--The Secretary of the Treasury, in consultation 
with the Secretary of Health and Human Services, shall for each fiscal 
year determine the amount of savings to the Federal Government as a 
result of the enactment of this subtitle.
    (b) Use.--Notwithstanding any other provision of this subtitle (or 
an amendment made by this subtitle), the savings to the Federal 
Government generated as a result of the enactment of this subtitle 
shall be used for deficit reduction.

  Subtitle B--More Affordable Medicines for Children and Underserved 
                              Communities

SEC. 611. EXPANDED PARTICIPATION IN 340B PROGRAM.

    (a) Expansion of Covered Entities Receiving Discounted Prices.--
Section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 
256b(a)(4)) is amended by adding at the end the following:
                    ``(M) A children's hospital excluded from the 
                Medicare prospective payment system pursuant to section 
                1886(d)(1)(B)(iii) of the Social Security Act, or a 
                free-standing cancer hospital excluded from the 
                Medicare prospective payment system pursuant to section 
                1886(d)(1)(B)(v) of the Social Security Act, that would 
                meet the requirements of subparagraph (L), including 
                the disproportionate share adjustment percentage 
                requirement under clause (ii) of such subparagraph, if 
                the hospital were a subsection (d) hospital as defined 
                by section 1886(d)(1)(B) of the Social Security Act.
                    ``(N) An entity that is a critical access hospital 
                (as determined under section 1820(c)(2) of the Social 
                Security Act), and that meets the requirements of 
                subparagraph (L)(i).
                    ``(O) An entity that is a rural referral center, as 
                defined by section 1886(d)(5)(C)(i) of the Social 
                Security Act, or a sole community hospital, as defined 
                by section 1886(d)(5)(C)(iii) of such Act, and that 
                both meets the requirements of subparagraph (L)(i) and 
                has a disproportionate share adjustment percentage 
                equal to or greater than 8 percent.''.
    (b) Extension of Discount to Inpatient Drugs.--Section 340B of the 
Public Health Service Act (42 U.S.C. 256b) is amended--
            (1) in paragraphs (2), (5), (7), and (9) of subsection (a), 
        by striking ``outpatient'' each place it appears; and
            (2) in subsection (b)--
                    (A) by striking ``Other Definition'' and all that 
                follows through ``In this section'' and inserting the 
                following: ``Other Definitions.--
            ``(1) In general.--In this section''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(2) Covered drug.--In this section, the term `covered 
        drug'--
                    ``(A) means a covered outpatient drug (as defined 
                in section 1927(k)(2) of the Social Security Act); and
                    ``(B) includes, notwithstanding paragraph (3)(A) of 
                section 1927(k) of such Act, a drug used in connection 
                with an inpatient or outpatient service provided by a 
                hospital described in subparagraph (L), (M), (N), or 
                (O) of subsection (a)(4) that is enrolled to 
                participate in the drug discount program under this 
                section.''.
    (c) Prohibition on Group Purchasing Arrangements.--Section 340B(a) 
of the Public Health Service Act (42 U.S.C. 256b(a)) is amended--
            (1) in paragraph (4)(L)--
                    (A) in clause (i), by adding ``and'' at the end;
                    (B) in clause (ii), by striking ``; and'' and 
                inserting a period; and
                    (C) by striking clause (iii); and
            (2) in paragraph (5), as amended by subsection (b)--
                    (A) by redesignating subparagraphs (C) and (D) as 
                subparagraphs (D) and (E); respectively; and
                    (B) by inserting after subparagraph (B), the 
                following:
                    ``(C) Prohibition on group purchasing 
                arrangements.--
                            ``(i) In general.--A hospital described in 
                        subparagraph (L), (M), (N), or (O) of paragraph 
                        (4) shall not obtain covered outpatient drugs 
                        through a group purchasing organization or 
                        other group purchasing arrangement, except as 
                        permitted or provided for pursuant to clauses 
                        (ii) or (iii).
                            ``(ii) Inpatient drugs.--Clause (i) shall 
                        not apply to drugs purchased for inpatient use.
                            ``(iii) Exceptions.--The Secretary shall 
                        establish reasonable exceptions to clause (i)--
                                    ``(I) with respect to a covered 
                                outpatient drug that is unavailable to 
                                be purchased through the program under 
                                this section due to a drug shortage 
                                problem, manufacturer noncompliance, or 
                                any other circumstance beyond the 
                                hospital's control;
                                    ``(II) to facilitate generic 
                                substitution when a generic covered 
                                outpatient drug is available at a lower 
                                price; or
                                    ``(III) to reduce in other ways the 
                                administrative burdens of managing both 
                                inventories of drugs subject to this 
                                section and inventories of drugs that 
                                are not subject to this section, so 
                                long as the exceptions do not create a 
                                duplicate discount problem in violation 
                                of subparagraph (A) or a diversion 
                                problem in violation of subparagraph 
                                (B).
                            ``(iv) Purchasing arrangements for 
                        inpatient drugs.--The Secretary shall ensure 
                        that a hospital described in subparagraph (L), 
                        (M), (N), or (O) of subsection (a)(4) that is 
                        enrolled to participate in the drug discount 
                        program under this section shall have multiple 
                        options for purchasing covered drugs for 
                        inpatients, including by utilizing a group 
                        purchasing organization or other group 
                        purchasing arrangement, establishing and 
                        utilizing its own group purchasing program, 
                        purchasing directly from a manufacturer, and 
                        any other purchasing arrangements that the 
                        Secretary determines is appropriate to ensure 
                        access to drug discount pricing under this 
                        section for inpatient drugs taking into account 
                        the particular needs of small and rural 
                        hospitals.''.
    (d) Medicaid Credits on Inpatient Drugs.--Section 340B of the 
Public Health Service Act (42 U.S.C. 256b) is amended by striking 
subsection (c) and inserting the following:
    ``(c) Medicaid Credit.--Not later than 90 days after the date of 
filing of the hospital's most recently filed Medicare cost report, the 
hospital shall issue a credit as determined by the Secretary to the 
State Medicaid program for inpatient covered drugs provided to Medicaid 
recipients.''.
    (e) Effective Dates.--
            (1) In general.--The amendments made by this section and 
        section 612 shall take effect on January 1, 2010, and shall 
        apply to drugs purchased on or after January 1, 2010.
            (2) Effectiveness.--The amendments made by this section and 
        section 612 shall be effective and shall be taken into account 
        in determining whether a manufacturer is deemed to meet the 
        requirements of section 340B(a) of the Public Health Service 
        Act (42 U.S.C. 256b(a)), notwithstanding any other provision of 
        law.

SEC. 612. IMPROVEMENTS TO 340B PROGRAM INTEGRITY.

    (a) Integrity Improvements.--Subsection (d) of section 340B of the 
Public Health Service Act (42 U.S.C. 256b) is amended to read as 
follows:
    ``(d) Improvements in Program Integrity.--
            ``(1) Manufacturer compliance.--
                    ``(A) In general.--From amounts appropriated under 
                paragraph (4), the Secretary shall provide for 
                improvements in compliance by manufacturers with the 
                requirements of this section in order to prevent 
                overcharges and other violations of the discounted 
                pricing requirements specified in this section.
                    ``(B) Improvements.--The improvements described in 
                subparagraph (A) shall include the following:
                            ``(i) The development of a system to enable 
                        the Secretary to verify the accuracy of ceiling 
                        prices calculated by manufacturers under 
                        subsection (a)(1) and charged to covered 
                        entities, which shall include the following:
                                    ``(I) Developing and publishing 
                                through an appropriate policy or 
                                regulatory issuance, precisely defined 
                                standards and methodology for the 
                                calculation of ceiling prices under 
                                such subsection.
                                    ``(II) Comparing regularly the 
                                ceiling prices calculated by the 
                                Secretary with the quarterly pricing 
                                data that is reported by manufacturers 
                                to the Secretary.
                                    ``(III) Performing spot checks of 
                                sales transactions by covered entities.
                                    ``(IV) Inquiring into the cause of 
                                any pricing discrepancies that may be 
                                identified and either taking, or 
                                requiring manufacturers to take, such 
                                corrective action as is appropriate in 
                                response to such price discrepancies.
                            ``(ii) The establishment of procedures for 
                        manufacturers to issue refunds to covered 
                        entities in the event that there is an 
                        overcharge by the manufacturers, including the 
                        following:
                                    ``(I) Providing the Secretary with 
                                an explanation of why and how the 
                                overcharge occurred, how the refunds 
                                will be calculated, and to whom the 
                                refunds will be issued.
                                    ``(II) Oversight by the Secretary 
                                to ensure that the refunds are issued 
                                accurately and within a reasonable 
                                period of time, both in routine 
                                instances of retroactive adjustment to 
                                relevant pricing data and exceptional 
                                circumstances such as erroneous or 
                                intentional overcharging for covered 
                                drugs.
                            ``(iii) The provision of access through the 
                        Internet website of the Department of Health 
                        and Human Services to the applicable ceiling 
                        prices for covered drugs as calculated and 
                        verified by the Secretary in accordance with 
                        this section, in a manner (such as through the 
                        use of password protection) that limits such 
                        access to covered entities and adequately 
                        assures security and protection of privileged 
                        pricing data from unauthorized re-disclosure.
                            ``(iv) The development of a mechanism by 
                        which--
                                    ``(I) rebates and other discounts 
                                provided by manufacturers to other 
                                purchasers subsequent to the sale of 
                                covered drugs to covered entities are 
                                reported to the Secretary; and
                                    ``(II) appropriate credits and 
                                refunds are issued to covered entities 
                                if such discounts or rebates have the 
                                effect of lowering the applicable 
                                ceiling price for the relevant quarter 
                                for the drugs involved.
                            ``(v) Selective auditing of manufacturers 
                        and wholesalers to ensure the integrity of the 
                        drug discount program under this section.
                            ``(vi) The imposition of sanctions in the 
                        form of civil monetary penalties, which--
                                    ``(I) shall be assessed according 
                                to standards established in regulations 
                                to be promulgated by the Secretary not 
                                later than 180 days after the date of 
                                enactment of Affordable Health Choices 
                                Act;
                                    ``(II) shall not exceed $5,000 for 
                                each instance of overcharging a covered 
                                entity that may have occurred; and
                                    ``(III) shall apply to any 
                                manufacturer with an agreement under 
                                this section that knowingly and 
                                intentionally charges a covered entity 
                                a price for purchase of a drug that 
                                exceeds the maximum applicable price 
                                under subsection (a)(1).
            ``(2) Covered entity compliance.--
                    ``(A) In general.--From amounts appropriated under 
                paragraph (4), the Secretary shall provide for 
                improvements in compliance by covered entities with the 
                requirements of this section in order to prevent 
                diversion and violations of the duplicate discount 
                provision and other requirements specified under 
                subsection (a)(5).
                    ``(B) Improvements.--The improvements described in 
                subparagraph (A) shall include the following:
                            ``(i) The development of procedures to 
                        enable and require covered entities to 
                        regularly update (at least annually) the 
                        information on the Internet website of the 
                        Department of Health and Human Services 
                        relating to this section.
                            ``(ii) The development of a system for the 
                        Secretary to verify the accuracy of information 
                        regarding covered entities that is listed on 
                        the website described in clause (i).
                            ``(iii) The development of more detailed 
                        guidance describing methodologies and options 
                        available to covered entities for billing 
                        covered drugs to State Medicaid agencies in a 
                        manner that avoids duplicate discounts pursuant 
                        to subsection (a)(5)(A).
                            ``(iv) The establishment of a single, 
                        universal, and standardized identification 
                        system by which each covered entity site can be 
                        identified by manufacturers, distributors, 
                        covered entities, and the Secretary for 
                        purposes of facilitating the ordering, 
                        purchasing, and delivery of covered drugs under 
                        this section, including the processing of 
                        chargebacks for such drugs.
                            ``(v) The imposition of sanctions, in 
                        appropriate cases as determined by the 
                        Secretary, additional to those to which covered 
                        entities are subject under subparagraph 
                        (a)(5)(E), through one or more of the following 
                        actions:
                                    ``(I) Where a covered entity 
                                knowingly and intentionally violates 
                                subparagraph (a)(5)(B), the covered 
                                entity shall be required to pay a 
                                monetary penalty to a manufacturer or 
                                manufacturers in the form of interest 
                                on sums for which the covered entity is 
                                found liable under paragraph (a)(5)(E), 
                                such interest to be compounded monthly 
                                and equal to the current short term 
                                interest rate as determined by the 
                                Federal Reserve for the time period for 
                                which the covered entity is liable.
                                    ``(II) Where the Secretary 
                                determines a violation of subparagraph 
                                (a)(5)(B) was systematic and egregious 
                                as well as knowing and intentional, 
                                removing the covered entity from the 
                                drug discount program under this 
                                section and disqualifying the entity 
                                from re-entry into such program for a 
                                reasonable period of time to be 
                                determined by the Secretary.
                                    ``(III) Referring matters to 
                                appropriate Federal authorities within 
                                the Food and Drug Administration, the 
                                Office of Inspector General of 
                                Department of Health and Human 
                                Services, or other Federal agencies for 
                                consideration of appropriate action 
                                under other Federal statutes, such as 
                                the Prescription Drug Marketing Act (21 
                                U.S.C. 353).
            ``(3) Administrative dispute resolution process.--
                    ``(A) In general.--Not later than 180 days after 
                the date of enactment of Affordable Health Choices Act, 
                the Secretary shall promulgate regulations to establish 
                and implement an administrative process for the 
                resolution of claims by covered entities that they have 
                been overcharged for drugs purchased under this 
                section, and claims by manufacturers, after the conduct 
                of audits as authorized by subsection (a)(5)(D), of 
                violations of subsections (a)(5)(A) or (a)(5)(B), 
                including appropriate procedures for the provision of 
                remedies and enforcement of determinations made 
                pursuant to such process through mechanisms and 
                sanctions described in paragraphs (1)(B) and (2)(B).
                    ``(B) Deadlines and procedures.--Regulations 
                promulgated by the Secretary under subparagraph (A) 
                shall--
                            ``(i) designate or establish a decision-
                        making official or decision-making body within 
                        the Department of Health and Human Services to 
                        be responsible for reviewing and finally 
                        resolving claims by covered entities that they 
                        have been charged prices for covered drugs in 
                        excess of the ceiling price described in 
                        subsection (a)(1), and claims by manufacturers 
                        that violations of subsection (a)(5)(A) or 
                        (a)(5)(B) have occurred;
                            ``(ii) establish such deadlines and 
                        procedures as may be necessary to ensure that 
                        claims shall be resolved fairly, efficiently, 
                        and expeditiously;
                            ``(iii) establish procedures by which a 
                        covered entity may discover and obtain such 
                        information and documents from manufacturers 
                        and third parties as may be relevant to 
                        demonstrate the merits of a claim that charges 
                        for a manufacturer's product have exceeded the 
                        applicable ceiling price under this section, 
                        and may submit such documents and information 
                        to the administrative official or body 
                        responsible for adjudicating such claim;
                            ``(iv) require that a manufacturer conduct 
                        an audit of a covered entity pursuant to 
                        subsection (a)(5)(D) as a prerequisite to 
                        initiating administrative dispute resolution 
                        proceedings against a covered entity;
                            ``(v) permit the official or body 
                        designated under clause (i), at the request of 
                        a manufacturer or manufacturers, to consolidate 
                        claims brought by more than one manufacturer 
                        against the same covered entity where, in the 
                        judgment of such official or body, 
                        consolidation is appropriate and consistent 
                        with the goals of fairness and economy of 
                        resources; and
                            ``(vi) include provisions and procedures to 
                        permit multiple covered entities to jointly 
                        assert claims of overcharges by the same 
                        manufacturer for the same drug or drugs in one 
                        administrative proceeding, and permit such 
                        claims to be asserted on behalf of covered 
                        entities by associations or organizations 
                        representing the interests of such covered 
                        entities and of which the covered entities are 
                        members.
                    ``(C) Finality of administrative resolution.--The 
                administrative resolution of a claim or claims under 
                the regulations promulgated under subparagraph (A) 
                shall be a final agency decision and shall be binding 
                upon the parties involved, unless invalidated by an 
                order of a court of competent jurisdiction.
            ``(4) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this subsection, 
        such sums as may be necessary for fiscal year 2010 and each 
        succeeding fiscal year.''.
    (b) Conforming Amendments.--Section 340B(a) of the Public Health 
Service Act (42 U.S.C. 256b(a)) is amended--
            (1) in subsection (a)(1), by adding at the end the 
        following: ``Each such agreement shall require that the 
        manufacturer furnish the Secretary with reports, on a quarterly 
        basis, of the price for each covered drug subject to the 
        agreement that, according to the manufacturer, represents the 
        maximum price that covered entities may permissibly be required 
        to pay for the drug (referred to in this section as the 
        `ceiling price'), and shall require that the manufacturer offer 
        each covered entity covered drugs for purchase at or below the 
        applicable ceiling price if such drug is made available to any 
        other purchaser at any price.''; and
            (2) in the first sentence of subsection (a)(5)(E), as 
        redesignated by section 611(c), by inserting ``after audit as 
        described in subparagraph (D) and'' after ``finds,''.

SEC. 613. GAO STUDY TO MAKE RECOMMENDATIONS ON IMPROVING THE 340B 
              PROGRAM.

    (a) Report.--Not later than 18 months after the date of enactment 
of this Act, the Comptroller General of the United States shall submit 
to Congress a report that examines whether those individuals served by 
the covered entities under the program under section 340B of the Public 
Health Service Act (42 U.S.C. 256b) (referred to in this section as the 
``340B program'') are receiving optimal health care services.
    (b) Recommendations.--The report under subsection (a) shall include 
recommendations on the following:
            (1) Whether the 340B program should be expanded since it is 
        anticipated that the 47,000,000 individuals who are uninsured 
        as of the date of enactment of this Act will have health care 
        coverage once this Act is implemented.
            (2) Whether mandatory sales of certain products by the 340B 
        program could hinder patients access to those therapies through 
        any provider.
            (3) Whether income from the 340B program is being used by 
        the covered entities under the program to further the program 
        objectives.
                                                       Calendar No. 161

111th CONGRESS

  1st Session

                                S. 1679

_______________________________________________________________________

                                 A BILL

  To make quality, affordable health care available to all Americans, 
reduce costs, improve health care quality, enhance disease prevention, 
               and strengthen the health care workforce.

_______________________________________________________________________

                           September 17, 2009

                 Read twice and placed on the calendar