[Congressional Record Volume 155, Number 177 (Wednesday, December 2, 2009)]
[Senate]
[Pages S12164-S12258]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 2798. Mr. INOUYE submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of subtitle D of title V, add the following:

     SEC. 5316. DEMONSTRATION GRANTS FOR FAMILY NURSE PRACTITIONER 
                   TRAINING PROGRAMS.

       (a) Establishment of Program.--The Secretary of Health and 
     Human Services (referred to in this section as the 
     ``Secretary'') shall establish a training demonstration 
     program for family nurse practitioners (referred to in this 
     section as the ``program'') to employ and provide intensive, 
     one-year training for nurse practitioners who have graduated 
     from a nurse practitioner program not more than 18 months 
     prior to commencing such training, for careers as primary 
     care providers in Federally qualified health centers 
     (referred to in this section as ``FQHCs'') and nurse-managed 
     health clinics, in order to increase access to primary care 
     in impoverished, urban, and rural underserved communities.
       (b) Purpose.--The purpose of the program is to enable each 
     grant recipient to--
       (1) provide new nurse practitioners with a depth, breadth, 
     volume, and intensity of clinical training necessary to serve 
     as primary care providers in the complex settings of FQHCs 
     and nurse-managed health clinics;
       (2) train new nurse practitioners to work under a model of 
     primary care, including the use of electronic health records, 
     planned care and chronic care models, and interdisciplinary 
     team-based care, that is consistent with--
       (A) the principles of health care set forth by the 
     Institute of Medicine; and
       (B) the needs of vulnerable populations;
       (3) create a model of FQHC- and nurse-managed health 
     clinic-based training for nurse practitioners that may be 
     replicated nationwide; and
       (4) provide additional intensive learning experiences with 
     high-volume, high-risk, or high-burden problems commonly 
     encountered in FQHCs and nurse-managed health clinics, such 
     as HIV/AIDS, prenatal care, orthopedics, geriatrics, 
     diabetes, asthma, and obesity prevention.
       (c) Grants.--The Secretary shall award grants to eligible 
     entities that meet the eligibility requirements established 
     by the Secretary, for the purpose of operating the nurse 
     practitioner primary care programs described in subsection 
     (a) in such entities.
       (d) Eligible Entities.--To be eligible to receive a grant 
     under this section, an entity shall--
       (1)(A) be a FQHC as defined in section 1861(aa) of the 
     Social Security Act (42 U.S.C. 1395x(aa)); or
       (B) be a nurse-managed health clinic, as defined in section 
     330A-1 of the Public Health Service Act (as added by section 
     5208 of this Act); and
       (2) submit to the Secretary an application at such time, in 
     such manner, and containing such information as the Secretary 
     may require.
       (e) Priority in Awarding Grants.--In awarding grants under 
     this section, the Secretary shall give priority to eligible 
     entities that--
       (1) demonstrate sufficient infrastructure in size, scope, 
     and capacity to undertake the requisite training of a minimum 
     of 3 nurse practitioners per year and the half-time 
     employment of a qualified program coordinator;
       (2) will provide that each such program will entail 12-full 
     months of full-time, paid employment for each awardee, and 
     will offer each awardee benefits consistent with the benefits 
     offered to other full-time employees of such entity;
       (3) will assign not less than 1 staff nurse practitioner or 
     physician to each of 4 precepted clinics, in which the 
     awardee is the primary provider for the patient, per week, 
     and during such clinics, ensure that the assigned staff nurse 
     practitioner or physician shall be available exclusively to 
     the awardees and have no other assigned clinical or 
     administrative duties;
       (4) will provide to each awardee specialty rotations 
     consisting of 3 sessions per week, either within or outside 
     of the FQHC or nurse-managed health clinic, based upon the 
     capability of the FQHC or nurse-managed health clinic to 
     provide specialty training in prenatal care and women's 
     health, adult and child psychiatry, orthopedics, geriatrics, 
     and at least 3 other high-volume, high-burden specialty 
     areas, such as HIV/AIDS, dermatology, cardiology, diabetes, 
     asthma, urgent care (minor trauma), and pain management;
       (5) enable awardees to practice alongside other primary 
     care providers so that the awardees may consult with such 
     primary care providers as necessary;
       (6) provide educational and didactic sessions on high-
     volume, high-risk health problems;
       (7) have implemented (or will complete, not later than the 
     beginning of the program, implementation of) health 
     information technology, and will make use of an electronic 
     training evaluation system;
       (8) provide continuous training to a FQHC standard of a 
     high performance health system that includes access to health 
     care, continuity, planned care, team-based, prevention-
     focused care that includes the use of electronic health 
     records and other health information technology;
       (9) have a record of recruiting, training, caring for, and 
     otherwise demonstrating competency in advancing the primary 
     care of individuals who are from underrepresented minority 
     groups or from a poor urban or rural, or otherwise 
     disadvantaged background;
       (10) have a record of training health care professionals 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; and
       (11) have a record of collaboration with other safety net 
     providers, schools, colleges, and universities that provide 
     health professions training, establish formal relationships, 
     and submit joint applications with rural health clinics, area 
     health education centers, and community health centers 
     located in underserved areas, or that serve underserved 
     populations.
       (f) Eligibility of Awardees.--
       (1) In general.--To be eligible for acceptance to a nurse 
     practitioner training program funded through a grant awarded 
     under this section, an individual shall--
       (A) be licensed or eligible for licensure in the State in 
     which the program is located as an advanced practice 
     registered nurse or advanced practice nurse and be eligible 
     or board-certified as a family nurse practitioner; and
       (B) demonstrate commitment to a career as a primary care 
     provider in a FQHC or in a nurse-managed health clinic.
       (2) Preference.--In selecting awardees under the program, 
     each recipient of a grant under this section shall give 
     preference to bilingual candidates that meet the requirements 
     described in paragraph (1).
       (3) Deferral of certain service.--The starting date of 
     required service of individuals in the National Health 
     Service Corps Service program under title II of the Public 
     Health Service Act (42 U.S.C. 202 et seq.) who receive 
     training under this section shall be deferred until the date 
     that is 90 days after the completion of the program.
       (4) Awardee defined.--In this section, the term ``awardee'' 
     means an individual who has been accepted into a nurse 
     practitioner training program funded through a grant awarded 
     under this section.
       (g) Duration of Awards.--Each grant awarded under this 
     section shall be for a period of 3 years. A grant recipient 
     may carry over funds from one fiscal year to another without 
     obtaining approval from the Secretary.
       (h) Grant Amount.--Each grant awarded under this section 
     shall be in an amount not to exceed $600,000 per year, as 
     determined by the Secretary, taking into account--
       (1) the financial need of the FQHC or nurse-managed health 
     clinic, considering, Federal, State, local, and other 
     operational

[[Page S12165]]

     funding provided to the FQHC or nurse-managed health clinic; 
     and
       (2) other factors, as the Secretary determines appropriate.
       (i) Technical Assistance Grants.--The Secretary may award 
     technical assistance grants to FQHCs and nurse-managed health 
     clinics that plan to establish, or that have established, a 
     nurse practitioner residency training program. The Secretary 
     shall award a technical assistance grant to 1 FQHC that has 
     expertise in establishing a nurse practitioner residency 
     program, for the purpose of providing technical assistance to 
     other recipients of grants under this section.
       (j) Authorization of Appropriations.--To carry out this 
     section, there is authorized to be appropriated such sums as 
     may be necessary for each of fiscal years 2011 through 2014.
                                 ______
                                 
  SA 2799. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title I, insert the following:

     SEC. __. ENTITLEMENT REFORM.

       Notwithstanding any other provision of this Act (or an 
     amendment made by this Act), this Act (and amendments), other 
     than this section, shall not take effect until such time as 
     the Office of the Actuary for the Centers for Medicare & 
     Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) would reduce the 
     Federal budgetary commitment to health care by January 1, 
     2019, as compared to Federal budgetary commitment to health 
     care by January 1, 2019 that would have resulted if such Act 
     (and amendments) is not implemented.
                                 ______
                                 
  SA 2800. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title I, insert the following:

     SEC. __. LOWERING COSTS FOR FAMILIES.

       Notwithstanding any other provision of this Act (or an 
     amendment made by this Act), this Act (and amendments), other 
     than this section, shall not take effect until such time as 
     the Office of the Actuary for the Centers for Medicare & 
     Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) would reduce 
     annual health insurance premiums by $2,500 for the average 
     American family.
                                 ______
                                 
  SA 2801. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 354, after line 2, insert the following:
       ``(D) State election.--
       ``(i) In general.--At the election of a State, with respect 
     to any calendar year, if such State determines that such an 
     election will promote job creation or increase wages in such 
     State, subparagraphs (A) and (B) may be applied to months in 
     such calendar year by substituting `499' for `50' each place 
     it appears.
       ``(ii) Timing and manner of election.--Such election with 
     respect to any calendar year shall apply to all months in 
     such calendar year and shall be made at such time and in such 
     manner as the Secretary may provide.
                                 ______
                                 
  SA 2802. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 97, line 19, insert ``or after'' after ``enrolled 
     on''.
                                 ______
                                 
  SA 2803. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. MEMBERS OF CONGRESS REQUIRED TO HAVE COVERAGE UNDER 
                   MEDICAID INSTEAD OF THROUGH FEHBP.

       (a) In General.--Notwithstanding chapter 89 of title 5, 
     United States Code, title XIX of the Social Security Act, or 
     any provision of this Act, effective January 1, 2010--
       (1) each Member of Congress shall be eligible for medical 
     assistance under the Medicaid plan of the State in which the 
     Member resides; and
       (2) any employer contribution under chapter 89 of title 5 
     of such Code on behalf of the Member may be paid only to the 
     State agency responsible for administering the Medicaid plan 
     in which the Member enrolls and not to the offeror of a plan 
     offered through the Federal employees health benefit program 
     under such chapter.
       (b) Payments by Federal Government.--The Secretary of 
     Health and Human Services, in consultation with the Director 
     of the Office of Personnel Management, shall establish 
     procedures under which the employer contributions that would 
     otherwise be made on behalf of a Member of Congress if the 
     Member were enrolled in a plan offered through the Federal 
     employees health benefit program may be made directly to the 
     State agencies described in subsection (a).
       (c) Ineligible for FEHBP.--Effective January 1, 2010, no 
     Member of Congress shall be eligible to obtain health 
     insurance coverage under the program chapter 89 of title 5, 
     United States Code.
       (d) Definition.--In this section, the term ``Member of 
     Congress'' means any member of the House of Representatives 
     or the Senate.
                                 ______
                                 
  SA 2804. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 436, between lines 14 and 15, insert the following:

     SEC. 2008. NONAPPLICATION OF MEDICAID ELIGIBILITY EXPANSIONS 
                   UNTIL REDUCTION IN MEDICAID FRAUD RATE.

       Notwithstanding any other provision of this Act, any 
     provision of this Act or an amendment made by this Act that 
     imposes federally-mandated expansions of eligibility for 
     Medicaid shall not apply to any State before the date on 
     which the Secretary of Health and Human Services certifies 
     that the average payment error rate measurement (commonly 
     referred to as ``PERM'') for all State Medicaid programs does 
     not exceed 3.9 percent.
                                 ______
                                 
  SA 2805. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title I, insert the following:

     SEC. 1__. REQUIREMENT OF ELIMINATION OF THE FEDERAL DEFICIT.

       Notwithstanding any other provision of this Act (or an 
     amendment made by this Act), no Federal outlays authorized 
     under this Act (or such an amendment) may take effect until 
     the Office of Management and Budget certifies that the 
     Federal budget deficit has been eliminated.
                                 ______
                                 
  SA 2806. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title I, insert the following:

     SEC. __. ENSURING LOWER HEALTH CARE COSTS.

       Notwithstanding any other provision of this Act (or an 
     amendment made by this Act), this Act (and amendments), other 
     than this section, shall not take effect until such

[[Page S12166]]

     time as the Office of the Actuary for the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) would reduce 
     projected National Health Expenditures by January 1, 2019, as 
     compared to the projected National Health Expenditures by 
     January 1, 2019 that would have resulted if such Act (and 
     amendments) is not implemented.
                                 ______
                                 
  SA 2807. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 1000, strike line 19 and all that follows 
     through line 2 on page 1053.
                                 ______
                                 
  SA 2808. Mr. VITTER submitted an amendment intended to be proposed to 
amendment SA 2791 proposed by Ms. Mikulski (for herself, Mr. Harkin, 
Mrs. Boxer, and Mr. Franken) to the amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 2 of the amendment, after line 15 insert the 
     following:
       ``(5) for the purposes of this Act, and for the purposes of 
     any other provisions of law, the current recommendations of 
     the United States Preventive Service Task Force regarding 
     breast cancer screening, mammography, and prevention shall be 
     considered the most current other than those issued in or 
     around November 2009.''
                                 ______
                                 
  SA 2809. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1006, between lines 8 and 9, insert the following:
       ``(vii) The proposal shall not include any recommendation 
     that would reduce payment rates for items and services 
     furnished by providers of services or suppliers which would 
     have the effect of restricting access to treatment for 
     individuals with epilepsy.
                                 ______
                                 
  SA 2810. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 723, strike line 3 and all that follows 
     through page 739, line 17.

  SA 2811. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1006, between lines 8 and 9, insert the following:
       ``(vii) The proposal shall not include any recommendation 
     that would reduce payment rates for items and services 
     furnished by providers of services or suppliers which would 
     have the effect of restricting access to treatment for 
     individuals with childhood cancer.
                                 ______
                                 
  SA 2812. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 842, strike line 3 and all that follows 
     through page 846, line 10.
                                 ______
                                 
  SA 2813. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 923, between lines 7 and 8, insert the following:

     SEC. 3211. PROTECTING CHOICE AND COMPETITION FOR MEDICARE 
                   BENEFICIARIES.

       No provisions of, or amendments made by, this Act that 
     change the Medicare Advantage program under part C of title 
     XVIII of the Social Security Act in a manner that would 
     result in decreased choice and competition for Medicare 
     beneficiaries shall take effect and are repealed.
                                 ______
                                 
  SA 2814. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1006, between lines 8 and 9, insert the following:
       ``(vii) The proposal shall not include any recommendation 
     that would reduce payment rates for items and services 
     furnished by providers of services or suppliers which would 
     have the effect of restricting access to treatment for 
     individuals with juvenile diabetes.
                                 ______
                                 
  SA 2815. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1006, between lines 8 and 9, insert the following:
       ``(vii) The proposal shall not include any recommendation 
     that would reduce payment rates for items and services 
     furnished by providers of services or suppliers which would 
     have the effect of restricting access to treatment for 
     individuals with autism.
                                 ______
                                 
  SA 2816. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1006, between lines 8 and 9, insert the following:
       ``(vii) The proposal shall not include any recommendation 
     that would reduce payment rates for items and services 
     furnished by providers of services or suppliers which would 
     have the effect of restricting access to treatment for 
     individuals with cancer.
                                 ______
                                 
  SA 2817. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 828, strike line 5 and all that follows 
     through page 836, line 22.
                                 ______
                                 
  SA 2818. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1006, between lines 8 and 9, insert the following:
       ``(vii) The proposal shall not include any recommendation 
     that would reduce payment rates for items and services 
     furnished by providers of services or suppliers which would 
     have the effect of restricting access to treatment for 
     individuals with chronic obstructive pulmonary disease 
     (COPD).

[[Page S12167]]

                                 ______
                                 
  SA 2819. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 974, strike line 12 and all that follows 
     through page 999, line 16.
                                 ______
                                 
  SA 2820. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1006, between lines 8 and 9, insert the following:
       ``(vii) The proposal shall not include any recommendation 
     that would reduce payment rates for items and services 
     furnished by providers of services or suppliers located in 
     rural areas.
                                 ______
                                 
  SA 2821. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 869, strike line 17 and all that follows 
     through page 903, line 15.
                                 ______
                                 
  SA 2822. Mr. CRAPO submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 1000, strike line 19 and all that follows 
     through page 1053, line 2.
                                 ______
                                 
  SA 2823. Mr. COBURN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Strike section 2006.
                                 ______
                                 
  SA 2824. Mr. COBURN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Strike section 2953.
                                 ______
                                 
  SA 2825. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill H.R. 3590, to amend the Internal Revenue Code of 1986 
to modify the first-time homebuyers credit in the case of members of 
the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. _. BUREAUCRAT LIMITATION.

       For each new bureaucrat added to any department or agency 
     of the Federal Government for the purpose of implementing the 
     provisions of this Act (or any amendment made by this Act), 
     the head of such department or agency shall ensure that the 
     addition of such new bureaucrat is offset by a reduction of 1 
     existing bureaucrat at such department or agency.
                                 ______
                                 
  SA 2826. Mr. BENNET (for himself, Mr. Harkin, Mr. Dodd, Mr. Brown, 
Mr. Durbin, Mrs. Lincoln, Mr. Wyden, Mr. Begich, Mr. Bayh, and Mrs. 
Shaheen) submitted an amendment intended to be proposed to amendment SA 
2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 1134, between lines 3 and 4, insert the following:

   Subtitle G--Protecting and Improving Guaranteed Medicare Benefits

     SEC. 3601. PROTECTING AND IMPROVING GUARANTEED MEDICARE 
                   BENEFITS.

       (a) Protecting Guaranteed Medicare Benefits.--Nothing in 
     the provisions of, or amendments made by, this Act shall 
     result in a reduction of guaranteed benefits under title 
     XVIII of the Social Security Act.
       (b) Ensuring That Medicare Savings Benefit the Medicare 
     Program and Medicare Beneficiaries.--Savings generated for 
     the Medicare program under title XVIII of the Social Security 
     Act under the provisions of, and amendments made by, this Act 
     shall extend the solvency of the Medicare trust funds, reduce 
     Medicare premiums and other cost-sharing for beneficiaries, 
     and improve or expand guaranteed Medicare benefits and 
     protect access to Medicare providers.
                                 ______
                                 
  SA 2827. Mr. TESTER submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 1203, strike line 19 and all that follows 
     through page 1209, line 20 and insert the following:

     SEC. 4201. 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, prevent the 
     development of secondary conditions, address health 
     disparities, and develop a stronger evidence-base of 
     effective prevention programming, with not less than 20 
     percent of such grants being made to State or local 
     government agencies and community-based organizations located 
     in or serving, or both, rural areas.
       (b) Eligibility.--To be eligible to receive a grant under 
     subsection (a), an entity shall--
       (1) be--
       (A) a State governmental agency;
       (B) a local governmental agency;
       (C) a national network of community-based organizations;
       (D) a State or local non-profit organization; or
       (E) an 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 within and beyond health care and 
     across a community, such as healthy futures corps and health 
     care providers.
       (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, emotional 
     wellness, 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, improve social and emotional 
     wellness, 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;

[[Page S12168]]

       (vi) prioritizing strategies to reduce racial and ethnic 
     disparities, including social, economic, and geographic 
     determinants of health; and
       (vii) addressing special populations needs, including all 
     age groups and individuals with disabilities, and individuals 
     in both urban, rural, and frontier areas.
       (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 may 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) changes in emotional well-being and overall mental 
     health;
       (vi) other factors using community-specific data from the 
     Behavioral Risk Factor Surveillance Survey; and
       (vii) other factors as determined by the Secretary, 
     including differential susceptibility, mortality, or 
     morbidity due to chronic diseases such as cancer, diabetes, 
     and cardiovascular disease.
       (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 
     and the link between physical, emotional, and social well-
     being.
       (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. 4201A. REDUCTION OF HEALTH DISPARITIES IN RURAL AREAS.

       (a) Authorization of Initiative.--
       (1) In general.--The Secretary of Health and Human 
     Services, in collaboration or conjunction with the Director 
     of the National Center for Health Disparities and Deputy 
     Assistant Secretary for Minority Health, shall establish an 
     initiative--
       (A) that is specifically directed toward addressing the 
     issue of health disparities attributable to chronic diseases 
     in rural and frontier areas by creating and promoting 
     educational, screening, and outreach programs that reduce the 
     prevalence, morbidity, and mortality of chronic diseases or 
     susceptibility to such diseases; and
       (B) whose goal is to significantly improve access to, and 
     utilization of, beneficial chronic disease interventions in 
     rural communities experiencing health disparities in order to 
     reduce such disparities.
       (2) Health disparity population.--
       (A) In general.--For purposes of carrying out the 
     initiative described in paragraph (1), a population shall be 
     considered a health disparity population if there is a 
     significant disparity in the overall rate of chronic disease 
     incidence, prevalence, morbidity, mortality, or survival 
     rates in the population as compared to the health status of 
     the general population.
       (B) Chronic diseases.--In this paragraph, the term 
     ``chronic disease'' includes hypertension, diabetes, cancer, 
     and heart disease.
       (b) Common Administrative Structure.--The initiative 
     described in subsection (a) shall--
       (1) utilize a common administrative structure to ensure 
     coordinated implementation, oversight, and accountability;
       (2) be amenable to regional organization in order to meet 
     the specific needs of rural communities throughout the United 
     States; and
       (3) involve elements located in rural communities and 
     areas.
       (c) Design.--The initiative described in subsection (a) 
     shall be designed to reach rural communities and populations 
     that experience a disproportionate share of chronic disease 
     burden, including African Americans, American Indians or 
     Alaska Natives, Hawaiian Natives and other Pacific Islanders, 
     Asians, Hispanics or Latinos, and other underserved rural 
     populations.
       (d) Establishment of Initiative and Grants.--In carrying 
     out the initiative described in subsection (a), the Secretary 
     of Health and Human Services shall, from funds appropriated 
     to carry out this section--
       (1) use 50 percent for the establishment of such 
     initiative; and
       (2) use 50 percent to award competitive grants or contracts 
     to organizations, universities, or similar entities to carry 
     out the initiative, with preference given to entities having 
     a demonstrable track record of service to rural communities, 
     including tribally-affiliated colleges or universities.
                                 ______
                                 
  SA 2828. Mr. WHITEHOUSE (for himself, Mr. Kerry, Mr. Feingold, and 
Mr. Franken) submitted an amendment intended to be proposed by him to 
the bill H.R. 3590, to amend the Internal Revenue code of 1986 to 
modify the first-time homebuyers credit in the case of members of the 
Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

                     TITLE __--MEDICAL BANKRUPTCIES

     SECTION __1. SHORT TITLE.

       This title may be cited as the ``Medical Bankruptcy 
     Fairness Act of 2009''.

     SEC. __2. DEFINITIONS.

       Section 101 of title 11, the United States Code, is amended 
     by inserting after paragraph (39A) the following:
       ``(39B) The term `medical debt' means any debt incurred 
     directly or indirectly as a result of the diagnosis, cure, 
     mitigation, treatment, or prevention of injury, deformity, or 
     disease, or for the purpose of affecting any structure or 
     function of the body.
       ``(39C) The term `medically distressed debtor' means a 
     debtor who, during any 12-month period during the 3 years 
     before the date of the filing of the petition--
       ``(A) incurred or paid medical debts for the debtor or a 
     dependent of the debtor, or a nondependent member of the 
     immediate family of the debtor (including any parent, 
     grandparent, sibling, child, grandchild, or spouse of the 
     debtor), that were not paid by any third party payor and were 
     in excess of 25 percent of the debtor's annual adjusted gross 
     income (as such term is defined under section 62 of the 
     Internal Revenue Code of 1986), set forth in the most recent 
     Federal income tax return filed by the debtor, or by the 
     debtor and the debtor's spouse, prior to the commencement of 
     the case;
       ``(B) was a member of a household in which 1 or more 
     members (including the debtor) lost all or substantially all 
     of the member's domestic support obligation income, taking 
     into consideration any disability insurance payments, for 4 
     or more weeks, due to a medical problem of a person obligated 
     to pay such domestic support; or
       ``(C) experienced a downgrade in employment status that 
     correlates to a reduction in wages or work hours or results 
     in unemployment, to care for an ill, injured, or disabled 
     dependent of the debtor, or an ill, injured, or disabled 
     nondependent member of the immediate family of the debtor 
     (including any parent, grandparent, sibling, child, 
     grandchild, or spouse of the debtor), for not less than 30 
     days.''.

     SEC. __3. EXEMPTIONS.

       (a) Exempt Property.--Section 522 of title 11, the United 
     States Code, is amended by adding at the end the following:
       ``(r) For a debtor who is a medically distressed debtor, if 
     the debtor elects to exempt property--
       ``(1) listed in subsection (b)(2), then in lieu of the 
     exemption provided under subsection (d)(1), the debtor may 
     elect to exempt the debtor's aggregate interest, not to 
     exceed $250,000 in value, in real property or personal 
     property that the debtor or a dependent of the debtor uses as 
     a residence, in a cooperative that owns property that the 
     debtor or a dependent of the debtor uses as a residence, or 
     in a burial plot for the debtor or a dependent of the debtor; 
     or
       ``(2) listed in subsection (b)(3), then if the exemption 
     provided under applicable law specifically for property of 
     the kind described in paragraph (1) is for less than $250,000 
     in value, the debtor may elect in lieu of such exemption to 
     exempt the debtor's aggregate interest, not to exceed 
     $250,000 in value, in any such real or personal property, 
     cooperative, or burial plot.''.
       (b) Conforming Amendments.--Sections 104(b)(1) and 
     104(b)(2) of title 11, the United States Code, are each 
     amended by inserting ``522(r),'' after ``522(q),''.

     SEC. __4. DISMISSAL OF A CASE OR CONVERSION TO A CASE UNDER 
                   CHAPTER 11 OR 13.

       Section 707(b) of title 11, the United States Code, is 
     amended by adding at the end the following:

[[Page S12169]]

       ``(8) No judge, United States trustee (or bankruptcy 
     administrator, if any), trustee, or other party in interest 
     may file a motion under paragraph (2) if the debtor is a 
     medically distressed debtor.''.

     SEC. __5. CREDIT COUNSELING.

       Section 109(h)(4) of title 11 United States Code, is 
     amended by inserting ``a medically distressed debtor or'' 
     after ``with respect to''.

     SEC. __6. NONDISCHARGEABILITY OF CERTAIN ATTORNEYS FEES.

       Section 523(a) of title 11, United States Code, is 
     amended--
       (1) in paragraph (18), by striking ``or'' at the end;
       (2) in paragraph (19), by striking the period at the end 
     and inserting ``; or''; and
       (3) by inserting after paragraph (19) the following:
       ``(20) in a case arising under chapter 7 of this title, 
     owed to an attorney as reasonable compensation for 
     representing the debtor in connection with the case.''.

     SEC. __7. EFFECTIVE DATE; APPLICATION OF AMENDMENTS.

       (a) Effective Date.--Except as provided in subsection (b), 
     this title and the amendments made by this title shall take 
     effect on the date of enactment of this Act.
       (b) Application of Amendments.--The amendments made by this 
     title shall apply only with respect to cases commenced under 
     title 11, United States Code, on or after the date of 
     enactment of this Act.

     SEC. __8. ATTESTATION BY DEBTOR.

       Any debtor who seeks relief as a medically distressed 
     debtor in accordance with the amendments made by this title 
     shall attest in writing and under penalty of perjury that the 
     medical expenses of the debtor were genuine, and were not 
     specifically incurred to bring the debtor within the coverage 
     of the medical bankruptcy provisions, as provided in this 
     title and the amendments made by this title.
                                 ______
                                 
  SA 2829. Mr. GRAHAM (for himself and Mr. Chambliss) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

                   TITLE __--MEDICAL LIABILITY REFORM

     SEC. _01. SHORT TITLE.

       This title may be cited as the ``Fair Resolution of Medical 
     Liability Disputes Act of 2009''.

     SEC. _02. FINDINGS.

       Congress finds that--
       (1) the health care and insurance industries are industries 
     affecting interstate commerce, and the health care 
     malpractice litigation systems throughout the United States 
     affect interstate commerce by contributing to the high cost 
     of health care and premiums for malpractice insurance 
     purchased by health care providers; and
       (2) the Federal Government, as a direct provider of health 
     care and as a source of payment for health care, has a major 
     interest in health care and a demonstrated interest in 
     assessing the quality of care, access to care, and the costs 
     of care through the evaluative activities of several Federal 
     agencies.

     SEC. _03. DEFINITIONS.

       In this title:
       (1) Alternative dispute resolution system; adr.--The term 
     ``alternative dispute resolution system'' or ``ADR'' means a 
     system established under this title that provides for the 
     resolution of covered health care malpractice claims in a 
     manner other than through a civil action in Federal or State 
     court.
       (2) Covered health care malpractice action.--The term 
     ``covered health care malpractice action'' means a civil 
     action in which a covered health care malpractice claim is 
     made against a health care provider or health care 
     professional.
       (3) Covered health care malpractice claim.--The term 
     ``covered health care malpractice claim'' means a malpractice 
     claim (excluding product liability claims) relating to the 
     provision of, or the failure to provide, health care services 
     involving a defendant covered health care professional or 
     provider.
       (4) Covered health care professional.--The term ``covered 
     health care professional'' means an individual, including a 
     physician, nurse, chiropractor, nurse midwife, physical 
     therapist, social worker, or physician assistant--
       (A) who provides health care services in a State;
       (B) for whom individuals entitled to, or enrolled for, 
     benefits under part A of title XVIII of the Social Security 
     Act (42 U.S.C. 1395c et seq.), or enrolled for benefits under 
     part B of such Act (42 U.S.C. 1395j et seq.) comprise not 
     less than 25 percent of the total patients of such 
     professional, as determined by the Secretary; and
       (C) who is required by State law or regulation to be 
     licensed or certified by a State a condition for providing 
     such services in the State.
       (5) Covered health care provider.--The term ``covered 
     health care provider'' means an organization or institution--
       (A) that is engaged in the delivery of health care services 
     in a State;
       (B) for which individuals entitled to, or enrolled for, 
     benefits under part A of title XVIII of the Social Security 
     Act (42 U.S.C. 1395c et seq.), or enrolled for benefits under 
     part B of such Act (42 U.S.C. 1395j et seq.) comprise not 
     less than 25 percent of the total patients of such 
     organization or institution, as determined by the Secretary; 
     and
       (C) that is required by State law or regulation to be 
     licensed or certified by the State as a condition for 
     engaging in the delivery of such services in the State.
       (6) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (7) State.--The term ``State'' means each of the several 
     States, the District of Columbia, Puerto Rico, the Virgin 
     Islands, Guam, American Samoa, and the Northern Mariana 
     Islands.

     SEC. _04. REQUIREMENT FOR INITIAL RESOLUTION OF ACTION 
                   THROUGH ALTERNATIVE DISPUTE RESOLUTION.

       (a) In General.--
       (1) State cases.--A covered health care malpractice action 
     may not be brought in any State court during a calendar year 
     unless the covered health care malpractice claim that is the 
     subject of the action has been initially resolved under an 
     alternative dispute resolution system certified for the year 
     by the Attorney General under section _06(a), or, in the case 
     of a State in which such a system is not in effect for the 
     year, under the alternative Federal system established under 
     section _06(b).
       (2) Federal diversity actions.--A covered health care 
     malpractice action may not be brought in a Federal court 
     under section 1332 of title 28, United States Code, during a 
     calendar year unless the covered health care malpractice 
     claim that is the subject of the action has been initially 
     resolved under the alternative dispute resolution system 
     described in paragraph (1) that applied in the State whose 
     law applies in such action.
       (b) Initial Resolution of Claims Under ADR.--For purposes 
     of subsection (a), an action is ``initially resolved'' under 
     an alternative dispute resolution system if--
       (1) the ADR reaches a decision on whether the defendant is 
     liable to the plaintiff for damages; and
       (2) if the ADR determines that the defendant is liable, the 
     ADR reaches a decision regarding the amount of damages 
     assessed against the defendant.
       (c) Procedures for Filing Actions.--
       (1) Notice of intent to contest decision.--
       (A) In general.--Not later than 60 days after a decision is 
     issued with respect to a covered health care malpractice 
     claim under an alternative dispute resolution system, each 
     party affected by the decision shall submit a sealed 
     statement to a court of competent jurisdiction, selected by 
     the arbitrator, indicating whether the party intends to 
     contest the decision.
       (B) Sealed statements.--Each sealed statement submitted to 
     a court under subparagraph (A) shall remain sealed until the 
     earlier of--
       (i) the date on which all affected parties have submitted 
     such statement; or
       (ii) the submission deadline described in subparagraph (A).
       (2) Requirements for filing action.--A covered health care 
     malpractice action may not be brought by a party unless--
       (A) such party files the action in a court of competent 
     jurisdiction not later than 90 days after the decision 
     resolving the covered health care malpractice claim that is 
     the subject of the action is issued under the applicable 
     alternative dispute resolution system; and
       (B) any party has filed the notice of intent required by 
     paragraph (1).
       (3) Court of competent jurisdiction.--For purposes of this 
     subsection, the term ``court of competent jurisdiction'' 
     means--
       (A) with respect to actions filed in a State court, the 
     appropriate State trial court; and
       (B) with respect to actions filed in a Federal court, the 
     appropriate United States district court.
       (d) Legal Effect of Uncontested ADR Decision.--A decision 
     reached under an alternative dispute resolution system that 
     is not contested under subsection (c) shall, for purposes of 
     enforcement by a court of competent jurisdiction, have the 
     same status in the court as the verdict of a covered health 
     care malpractice action adjudicated in a State or Federal 
     trial court.
       (e) Standard of Judicial Review.--The standard of judicial 
     review of a claim filed under subsection (c) shall be de 
     novo.
       (f) Award of Costs and Attorneys' Fees After Initial ADR 
     Resolution.--
       (1) In general.--In the case of a covered health care 
     malpractice action brought in any State or Federal court 
     after ADR, if the final judgment or order issued (exclusive 
     of costs, expenses, and attorneys' fees incurred after 
     judgment or trial) in the action is not more favorable to a 
     party contesting the ADR decision than the ADR decision, the 
     opposing party may file with the court, not later than 10 
     days after the final judgment or order is issued, a petition 
     for payment of costs and expenses, including attorneys' fees, 
     incurred with respect to the claim or claims after the date 
     of the ADR decision.
       (2) Award of costs and expenses.--If the court finds, under 
     a petition filed under paragraph (1), with respect to a claim 
     or claims, that the judgment or order finally obtained is not 
     more favorable to the party

[[Page S12170]]

     contesting the ADR decision with respect to the claim or 
     claims than the ADR decision, the court shall order the 
     contesting party to pay the costs and expenses of the 
     opposing party, including attorneys' fees, incurred with 
     respect to the claim or claims after the date of the ADR 
     decision, unless the court finds that requiring the payment 
     of such costs and expenses would be manifestly unjust.
       (3) Limitation.--Attorneys' fees awarded under this 
     subsection shall be in an amount reasonably attributable to 
     the claim or claims involved, calculated on the basis of an 
     hourly rate of the attorney, which may not exceed that which 
     the court considers acceptable in the community in which the 
     attorney practices law, taking into account the attorney's 
     qualifications and experience and the complexity of the case. 
     Attorneys' fees under this subsection may not exceed--
       (A) the actual cost incurred by the party for attorneys' 
     fees payable to an attorney for services in connection with 
     the claim or claims; or
       (B) if no such cost was incurred by the party due to a 
     contingency fee agreement, a reasonable cost that would have 
     been incurred by the party for noncontingent attorneys' fees 
     payable to an attorney for services in connection with the 
     claim or claims.
       (g) Applicability.--The requirements of this section shall 
     apply only to each covered health care malpractice claim 
     arising out of an event (or events) occurring on or after the 
     date that is 270 days after the date of enactment of this 
     Act.

     SEC. _05. BASIC REQUIREMENTS FOR STATE ALTERNATIVE DISPUTE 
                   RESOLUTION SYSTEMS.

       The alternative dispute resolution system of a State meets 
     the requirements of this section if the system--
       (1) applies to all covered health care malpractice claims 
     under the jurisdiction of the courts of such State;
       (2) requires that a written opinion resolving the dispute 
     be issued not later than 180 days after the date on which 
     each party against whom the claim is filed has received 
     notice of the claim (other than in exceptional cases for 
     which a longer period is required for the issuance of such an 
     opinion), and that the opinion contain--
       (A) findings of fact relating to the dispute; and
       (B) a description of the costs incurred in resolving the 
     dispute under the system (including any fees paid to the 
     individuals hearing and resolving the claim), together with 
     an appropriate assessment of the costs against any of the 
     parties;
       (3) requires individuals who hear and resolve claims under 
     the system to meet such qualifications as the State may 
     require (in accordance with regulations of the Attorney 
     General);
       (4) is approved by the State or by local governments in the 
     State;
       (5) with respect to a State system that consists of 
     multiple dispute resolution procedures--
       (A) permits the parties to a dispute to select the 
     procedure to be used for the resolution of the dispute under 
     the system; and
       (B) if the parties do not agree on the procedure to be used 
     for the resolution of the dispute, assigns a particular 
     procedure to the parties;
       (6) provides for the transmittal to the State agency 
     responsible for monitoring or disciplining health care 
     professionals and health care providers of any findings made 
     under the system that such a professional or provider 
     committed malpractice, unless, during the 90-day period 
     beginning on the date the system resolves the claim against 
     the professional or provider, the professional or provider 
     brings an action contesting the decision made under the 
     system; and
       (7) provides for the regular transmittal to the 
     Administrator of the Agency for Healthcare Research and 
     Quality of information on disputes resolved under the system, 
     in a manner that assures that the identity of the parties to 
     a dispute shall not be revealed.

     SEC. _06. CERTIFICATION OF STATE SYSTEMS; APPLICABILITY OF 
                   ALTERNATIVE FEDERAL SYSTEM.

       (a) Certification.--
       (1) In general.--Not later than 270 days after the date of 
     enactment of this Act and periodically thereafter, the 
     Attorney General, in consultation with the Secretary, shall 
     determine whether the alternative dispute resolution systems 
     of each State meet the requirements of this title.
       (2) Basis for certification.--The Attorney General shall 
     certify the alternative dispute resolution system of a State 
     under this subsection for a calendar year if the Attorney 
     General determines under paragraph (1) that such system meets 
     the requirements of section _05.
       (b) Applicability of Alternative Federal System.--
       (1) Establishment and applicability.--Not later than 270 
     days after the date of enactment of this Act, the Attorney 
     General, in consultation with the Secretary, shall establish 
     by rulemaking an alternative Federal ADR system for the 
     resolution of covered health care malpractice claims during a 
     calendar year, to be used for a calendar year in States that 
     do not have an alternative dispute resolution system that is 
     certified under subsection (a) for such year.
       (2) Requirements for system.--Under the alternative Federal 
     ADR system established under paragraph (1)--
       (A) paragraphs (1), (2), (6), and (7) of section _05 shall 
     apply to claims brought under such system;
       (B) the claims brought under such system shall be heard and 
     resolved by medical and legal experts appointed as 
     arbitrators by the Attorney General, in consultation with the 
     Secretary; and
       (C) with respect to a State in which such system is in 
     effect, the Attorney General may (at the request of such 
     State) modify the system to take into account the existence 
     of dispute resolution procedures in the State that affect the 
     resolution of health care malpractice claims.
       (3) Treatment of states with alternative system in 
     effect.--If the alternative Federal ADR system established 
     under this subsection is applied with respect to a State for 
     a calendar year such State shall reimburse the United States, 
     at such time and in such manner as the Secretary may require, 
     for the costs incurred by the United States during such year 
     as a result of the application of the system with respect to 
     the State.

     SEC. _07. GAO STUDY OF PRIVATE LITIGATION INSURANCE.

       The Comptroller General of the United States shall--
       (1) undertake a study of the effectiveness of private 
     litigation insurance markets, such as those in the United 
     Kingdom and Germany, in providing affordable access to 
     courts, evaluating the merit of prospective claims, and 
     ensuring that prevailing parties in ``loser pays'' systems 
     are reimbursed for attorneys' fees; and
       (2) not later than 270 days after the date of enactment of 
     this Act, submit to Congress a report describing the results 
     of such study.
  SA 2830. Mr. BROWNBACK (for himself and Mr. Lautenberg) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 143 of the amendment, after line 7, add the 
     following:

     SEC. 10011. CERTIFICATION.

       (a) In General.--This title (other than this section), and 
     the amendments made by this title, shall become effective 
     only if the Secretary of Health and Human Services certifies 
     to Congress that the implementation of this title, and the 
     amendments made by this title, will--
       (1) pose no additional risk to the public's health and 
     safety; and
       (2) result in a significant reduction in the cost of 
     covered products to the American consumer.
       (b) Effective Date.--Notwithstanding any other provision of 
     this title, or of any amendment made by this title--
       (1) any reference in this title, or in such amendments, to 
     the date of enactment of this title shall be deemed to be a 
     reference to the date of the certification under subsection 
     (a); and
       (2) each reference to ``January 1, 2012'' in section 
     10006(c) shall be substituted with ``90 days after the 
     effective date of this title''.

  SA 2831. Mr. JOHANNS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 436, between lines 14 and 15, insert the following:

     SEC. 2008. NONAPPLICATION OF ANY MEDICAID ELIGIBILITY 
                   EXPANSION UNTIL REDUCTION IN MEDICAID FRAUD 
                   RATE.

       Notwithstanding any other provision of this Act, with 
     respect to a State, any provision of this Act or an amendment 
     made by this Act that imposes a federally-mandated expansion 
     of eligibility for Medicaid shall not apply to the State 
     before the date on which the State Medicaid Director 
     certifies to the Secretary of Health and Human Services that 
     the Medicaid payment error rate measurement (commonly 
     referred to as ``PERM'') for the State does not exceed 5 
     percent.

  SA 2832. Mr. JOHANNS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 2074, after line 25, add the following:

[[Page S12171]]

     SEC. ___. DISTRIBUTION OF REMAINING BALANCES IN FLEXIBLE 
                   SPENDING ARRANGEMENTS UPON TERMINATION FROM 
                   EMPLOYMENT.

       (a) In General.--Section 125 of the Internal Revenue Code 
     of 1986 is amended by redesignating subsections (i) and (j) 
     as subsections (j) and (k), respectively, and by inserting 
     after subsection (h) the following new subsection:
       ``(i) Distribution of Remaining Balances in Flexible 
     Spending Arrangements Upon Termination From Employment.--
       ``(1) In general.--For purposes of this title, a plan or 
     other arrangement shall not fail to be treated as a health 
     flexible spending arrangement or a dependent care flexible 
     spending arrangement solely because under the plan or 
     arrangement a participant is permitted access to any unused 
     balance in the participant's accounts under such plan or 
     arrangement in the manner provided under paragraph (2).
       ``(2) Distribution upon termination.--
       ``(A) In general.--A plan or arrangement shall permit a 
     participant (or any designated heir of the participant) to 
     receive a cash payment equal to the aggregate unused account 
     balances in the plan or arrangement as of the date the 
     individual is separated (including by death or disability) 
     from employment with the employer maintaining the plan or 
     arrangement.
       ``(B) Inclusion in income.--Any payment under subparagraph 
     (A) shall be includible in gross income for the taxable year 
     in which such payment is distributed to the employee.
       ``(3) Terms relating to flexible spending arrangements.--
     For purposes of this section--
       ``(A) Flexible spending arrangements.--A flexible spending 
     arrangement is a benefit program which provides employees 
     with coverage under which specified incurred expenses may be 
     reimbursed (subject to reimbursement maximums and other 
     reasonable conditions).
       ``(B) Health and dependent care arrangements.--The terms 
     `health flexible spending arrangement' and `dependent care 
     flexible spending arrangement' means any flexible spending 
     arrangement (or portion thereof) which provides payments for 
     expenses incurred for medical care (as defined in section 
     213(d)) or dependent care (within the meaning of section 
     129), respectively.''.
       (b) Conforming Amendments.--
       (1) The heading for section 125 of the Internal Revenue 
     Code of 1986 is amended by inserting ``AND FLEXIBLE SPENDING 
     ARRANGEMENTS'' after ``PLANS''.
       (2) The item relating to section 125 in the table of 
     sections for part III of subchapter B of chapter 1 of such 
     Code is amended by inserting ``and flexible spending 
     arrangements'' after ``plans''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on the date of the enactment of this Act.
  SA 2833. Mr. JOHANNS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 436, between lines 14 and 15, insert the following:

     SEC. 2008. NONAPPLICATION OF ANY MEDICAID ELIGIBILITY 
                   EXPANSION UNTIL ENROLLMENT OF AT LEAST 90 
                   PERCENT OF CURRENTLY ELIGIBLE INDIVIDUALS.

       Notwithstanding any other provision of this Act, with 
     respect to a State, any provision of this Act or an amendment 
     made by this Act that imposes a federally-mandated expansion 
     of eligibility for Medicaid shall not apply to the State 
     before the date on which the State Medicaid Director 
     certifies to the Secretary of Health and Human Services that 
     at least 90 percent of the individuals eligible for medical 
     assistance under the State's Medicaid plan, including under 
     any waiver of such plan, are enrolled in the plan or waiver.
  SA 2834. Mr. JOHANNS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 340, between lines 21 and 22, insert the following:
       (e) Expedited Judicial Review.--If any action is brought to 
     challenge the constitutionality of section 5000A of the 
     Internal Revenue Code of 1986, as added by subsection (b), 
     the following rules shall apply:
       (1) The action shall be filed in the United States District 
     Court for the District of Columbia and shall be heard by a 3-
     judge court convened pursuant to section 2284 of title 28, 
     United States Code.
       (2) A copy of the complaint shall be delivered promptly to 
     the Clerk of the House of Representatives and the Secretary 
     of the Senate.
       (3) A final decision in the action shall be reviewable only 
     by appeal directly to the Supreme Court of the United States. 
     Such appeal shall be taken by the filing of a notice of 
     appeal within 10 days, and the filing of a jurisdictional 
     statement within 30 days, of the entry of the final decision.
       (4) It shall be the duty of the United States District 
     Court for the District of Columbia and the Supreme Court of 
     the United States to advance on the docket and to expedite to 
     the greatest possible extent the disposition of the action 
     and appeal.
  SA 2835. Mr. JOHANNS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1006, between lines 8 and 9, insert the following:
       ``(vii) The proposal shall not include any recommendation 
     that would reduce payment rates for items and services 
     furnished by a critical access hospital (as defined in 
     section 1861(mm)(1)).
                                 ______
                                 
  SA 2836. Ms. MURKOWSKI (for herself, Mrs. Hutchison, and Mr. Johanns) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 17, strike lines 11 through 14.
       On page 17, line 15, strike ``(2)'' and insert ``(1).''
       On page 17, line 20, strike ``(3)'' and insert ``(2)''.
       On page 17, between lines 24 and 25, insert the following:

     ``Notwithstanding any other provision of law, the Secretary 
     shall not use any recommendation made by the United States 
     Preventive Services Task Force to deny coverage of an item or 
     service by a group health plan or health insurance issuer 
     offering group or individual health insurance coverage or 
     under a Federal health care program (as defined in section 
     1128B(f) of the Social Security Act (42 U.S.C.1320a-7b(f))) 
     or private insurance.
       ``(b) Determinations of Benefits Coverage.--A group health 
     plan and a health insurance issuer offering group or 
     individual health insurance coverage shall, in determining 
     which preventive items and services to provide coverage for 
     under the plan or coverage, consult the medical guidelines 
     and recommendations of relevant professional medical 
     organizations of relevant medical practice areas (such as the 
     American Society of Clinical Oncology, the American College 
     of Surgeons, the American College of Radiation Oncology, the 
     American College of Obstetricians and Gynecologists, and 
     other similar organizations), including guidelines and 
     recommendations relating to the coverage of women's 
     preventive services (such as mammograms and cervical cancer 
     screenings). The plan or issuer shall disclose such 
     guidelines and recommendations to enrollees as part of the 
     summary of benefits and coverage explanation provided under 
     section 2715.''.
       On page 17, line 25, strike ``(b)'' and insert ``(c)''.
       On page 18, lines 3 and 4, strike ``or (a)(2)''.
       On page 18, line 4, strike ``(a)(3)'' and insert ``(a)(2)''
       On page 18, line 11, strike ``(c)'' and insert ``(d)''.
       On page 124, between lines 22 and 23, insert the following:
       (d) Rule of Construction With Respect to Preventive 
     Services.--Nothing in this Act (or an amendment made by this 
     Act) shall be construed to authorize the Secretary, or any 
     other governmental or quasi-governmental entity, to define or 
     classify abortion or abortion services as ``preventive care'' 
     or as a ``preventive service''.
       On page 1680, strike lines 10 through 12, and insert the 
     following:
       ``(A) to permit the Secretary to use data obtained from the 
     conduct of comparative effectiveness research, including such 
     research that is conducted or supported using funds 
     appropriated under the American Recovery and Reinvestment Act 
     of 2009 (Public Law 111-5), to deny coverage of an item or 
     service under a Federal health care program (as defined in 
     section 1128B(f)) or private insurance; or''.
                                 ______
                                 
  SA 2837. Mr. SANDERS (for himself, Mr. Burris, and Mr. Brown) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue

[[Page S12172]]

Code of 1986 to modify the first-time homebuyers credit in the case of 
members of the Armed Forces and certain other Federal employees, and 
for other purposes; which was ordered to lie on the table; as follows:

       Beginning on page 1, strike line 6 and all the follows to 
     the end and insert the following:
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

                   TITLE I--AMERICAN HEALTH SECURITY

Sec. 1000. Short title.

  Subtitle A--Establishment of a State-Based American Health Security 
               Program; Universal Entitlement; Enrollment

Sec. 1001. Establishment of a State-based American Health Security 
              Program.
Sec. 1002. Universal entitlement.
Sec. 1003. Enrollment.
Sec. 1004. Portability of benefits.
Sec. 1005. Effective date of benefits.
Sec. 1006. Relationship to existing Federal health programs.

 Subtitle B--Comprehensive Benefits, Including Preventive Benefits and 
                      Benefits for Long-Term Care

Sec. 1101. Comprehensive benefits.
Sec. 1102. Definitions relating to services.
Sec. 1103. Special rules for home and community-based long-term care 
              services.
Sec. 1104. Exclusions and limitations.
Sec. 1105. Certification; quality review; plans of care.

                   Subtitle C--Provider Participation

Sec. 1201. Provider participation and standards.
Sec. 1202. Qualifications for providers.
Sec. 1203. Qualifications for comprehensive health service 
              organizations.
Sec. 1204. Limitation on certain physician referrals.

                       Subtitle D--Administration

               PART I--General Administrative Provisions

Sec. 1301. American Health Security Standards Board.
Sec. 1302. American Health Security Advisory Council.
Sec. 1303. Consultation with private entities.
Sec. 1304. State health security programs.
Sec. 1305. Complementary conduct of related health programs.

                 PART II--Control Over Fraud and Abuse

Sec. 1310. Application of Federal sanctions to all fraud and abuse 
              under American Health Security Program.
Sec. 1311. Requirements for operation of State health care fraud and 
              abuse control units.

                     Subtitle E--Quality Assessment

Sec. 1401. American Health Security Quality Council.
Sec. 1402. Development of certain methodologies, guidelines, and 
              standards.
Sec. 1403. State quality review programs.
Sec. 1404. Elimination of utilization review programs; transition.

Subtitle F--Health Security Budget; Payments; Cost Containment Measures

                PART I--Budgeting and Payments to States

Sec. 1501. National health security budget.
Sec. 1502. Computation of individual and State capitation amounts.
Sec. 1503. State health security budgets.
Sec. 1504. Federal payments to States.
Sec. 1505. Account for health professional education expenditures.

                PART II--Payments by States to Providers

Sec. 1510. Payments to hospitals and other facility-based services for 
              operating expenses on the basis of approved global 
              budgets.
Sec. 1511. Payments to health care practitioners based on prospective 
              fee schedule.
Sec. 1512. Payments to comprehensive health service organizations.
Sec. 1513. Payments for community-based primary health services.
Sec. 1514. Payments for prescription drugs.
Sec. 1515. Payments for approved devices and equipment.
Sec. 1516. Payments for other items and services.
Sec. 1517. Payment incentives for medically underserved areas.
Sec. 1518. Authority for alternative payment methodologies.

      PART III--Mandatory Assignment and Administrative Provisions

Sec. 1520. Mandatory assignment.
Sec. 1521. Procedures for reimbursement; appeals.

 Subtitle G--Financing Provisions; American Health Security Trust Fund

Sec. 1530. Amendment of 1986 code; Section 15 not to apply.

              PART I--American Health Security Trust Fund

Sec. 1531. American Health Security Trust Fund.

                PART II--Taxes Based on Income and Wages

Sec. 1535. Payroll tax on employers.
Sec. 1536. Health care income tax.

  Subtitle H--Conforming Amendments to the Employee Retirement Income 
                          Security Act of 1974

Sec. 1601. ERISA inapplicable to health coverage arrangements under 
              State health security programs.
Sec. 1602. Exemption of State health security programs from ERISA 
              preemption.
Sec. 1603. Prohibition of employee benefits duplicative of benefits 
              under State health security programs; coordination in 
              case of workers' compensation.
Sec. 1604. Repeal of continuation coverage requirements under ERISA and 
              certain other requirements relating to group health 
              plans.
Sec. 1605. Effective date of subtitle.

              Subtitle I--Additional Conforming Amendments

Sec. 1701. Repeal of certain provisions in Internal Revenue Code of 
              1986.
Sec. 1702. Repeal of certain provisions in the Employee Retirement 
              Income Security Act of 1974.
Sec. 1703. Repeal of certain provisions in the Public Health Service 
              Act and related provisions.
Sec. 1704. Effective date of subtitle.

               TITLE II--HEALTH CARE QUALITY IMPROVEMENTS

Sec. 2001. Health care delivery system research; Quality improvement 
              technical assistance.
Sec. 2002. Establishing community health teams to support the patient-
              centered medical home.
Sec. 2003. Medication management services in treatment of chronic 
              disease.
Sec. 2004. Design and implementation of regionalized systems for 
              emergency care.
Sec. 2005. Program to facilitate shared decisionmaking.
Sec. 2006. Presentation of prescription drug benefit and risk 
              information.
Sec. 2007. Demonstration program to integrate quality improvement and 
              patient safety training into clinical education of health 
              professionals.
Sec. 2008. Improving women's health.
Sec. 2009. Patient navigator program.
Sec. 2010. Authorization of appropriations.

  TITLE III--PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH

  Subtitle A--Modernizing Disease Prevention and Public Health Systems

Sec. 3001. National Prevention, Health Promotion and Public Health 
              Council.
Sec. 3002. Prevention and Public Health Fund.
Sec. 3003. Clinical and community Preventive Services.
Sec. 3004. Education and outreach campaign regarding preventive 
              benefits.

     Subtitle B--Increasing Access to Clinical Preventive Services

Sec. 3101. School-based health centers.
Sec. 3102. Oral healthcare prevention activities.

               Subtitle C--Creating Healthier Communities

Sec. 3201. Community transformation grants.
Sec. 3202. Healthy aging, living well; evaluation of community-based 
              prevention and wellness programs.
Sec. 3203. Removing barriers and improving access to wellness for 
              individuals with disabilities.
Sec. 3204. Immunizations.
Sec. 3205. Nutrition labeling of standard menu items at Chain 
              Restaurants.
Sec. 3206. Demonstration project concerning individualized wellness 
              plan.
Sec. 3207. Reasonable break time for nursing mothers.

    Subtitle D--Support for Prevention and Public Health Innovation

Sec. 3301. Research on optimizing the delivery of public health 
              services.
Sec. 3302. Understanding health disparities: data collection and 
              analysis.
Sec. 3303. CDC and employer-based wellness programs.
Sec. 3304. Epidemiology-Laboratory Capacity Grants.
Sec. 3305. Advancing research and treatment for pain care management.
Sec. 3306. Funding for Childhood Obesity Demonstration Project.

                  Subtitle E--Miscellaneous Provisions

Sec. 3401. Sense of the Senate concerning CBO scoring.
Sec. 3402. Effectiveness of Federal health and wellness initiatives.

                    TITLE IV--HEALTH CARE WORKFORCE

                  Subtitle A--Purpose and Definitions

Sec. 4001. Purpose.
Sec. 4002. Definitions.

          Subtitle B--Innovations in the Health Care Workforce

Sec. 4101. National health care workforce commission.
Sec. 4102. State health care workforce development grants.
Sec. 4103. Health care workforce assessment.

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

Sec. 4201. Federally supported student loan funds.
Sec. 4202. Nursing student loan program.
Sec. 4203. Health care workforce loan repayment programs.

[[Page S12173]]

Sec. 4204. Public health workforce recruitment and retention programs.
Sec. 4205. Allied health workforce recruitment and retention programs.
Sec. 4206. Grants for State and local programs.
Sec. 4207. Funding for National Health Service Corps.
Sec. 4208. Nurse-managed health clinics.
Sec. 4209. Elimination of cap on commissioned corps.
Sec. 4210. Establishing a Ready Reserve Corps.

   Subtitle D--Enhancing Health Care Workforce Education and Training

Sec. 4301. Training in family medicine, general internal medicine, 
              general pediatrics, and physician assistantship.
Sec. 4302. Training opportunities for direct care workers.
Sec. 4303. Training in general, pediatric, and public health dentistry.
Sec. 4304. Alternative dental health care providers demonstration 
              project.
Sec. 4305. Geriatric education and training; career awards; 
              comprehensive geriatric education.
Sec. 4306. Mental and behavioral health education and training grants.
Sec. 4307. Cultural competency, prevention, and public health and 
              individuals with disabilities training.
Sec. 4308. Advanced nursing education grants.
Sec. 4309. Nurse education, practice, and retention grants.
Sec. 4310. Loan repayment and scholarship program.
Sec. 4311. Nurse faculty loan program.
Sec. 4312. Authorization of appropriations for parts B through D of 
              title VIII.
Sec. 4313. Grants to promote the community health workforce.
Sec. 4314. Fellowship training in public health.
Sec. 4315. United States Public Health Sciences Track.

       Subtitle E--Supporting the Existing Health Care Workforce

Sec. 4401. Centers of excellence.
Sec. 4402. Health care professionals training for diversity.
Sec. 4403. Interdisciplinary, community-based linkages.
Sec. 4404. Workforce diversity grants.
Sec. 4405. Primary care extension program.

Subtitle F--Strengthening Primary Care and Other Workforce Improvements

Sec. 4501. Demonstration projects To address health professions 
              workforce needs; extension of family-to-family health 
              information centers.
Sec. 4502. Increasing teaching capacity.
Sec. 4503. Graduate nurse education demonstration.

          Subtitle G--Improving Access to Health Care Services

Sec. 4601. Spending for Federally Qualified Health Centers (FQHCs).
Sec. 4602. Negotiated rulemaking for development of methodology and 
              criteria for designating medically underserved 
              populations and health professions shortage areas.
Sec. 4603. Reauthorization of the Wakefield Emergency Medical Services 
              for Children Program.
Sec. 4604. Co-locating primary and specialty care in community-based 
              mental health settings.
Sec. 4605. Key National indicators.

                     Subtitle H--General Provisions

Sec. 4701. Reports.

              TITLE V--TRANSPARENCY AND PROGRAM INTEGRITY

         Subtitle A--Physician Ownership and Other Transparency

Sec. 5001. Transparency reports and reporting of physician ownership or 
              investment interests.
Sec. 5002. Prescription drug sample transparency.

         Subtitle B--Nursing Home Transparency and Improvement

             PART I--Improving Transparency of Information

Sec. 5101. Required disclosure of ownership and additional disclosable 
              parties information.
Sec. 5102. Accountability requirements for skilled nursing facilities 
              and nursing facilities.
Sec. 5104. Standardized complaint form.
Sec. 5105. Ensuring staffing accountability.

                     PART II--Targeting Enforcement

Sec. 5111. Civil money penalties.
Sec. 5112. National independent monitor demonstration project.
Sec. 5113. Notification of facility closure.
Sec. 5114. National demonstration projects on culture change and use of 
              information technology in nursing homes.

                   PART III--Improving Staff Training

Sec. 5121. Dementia and abuse prevention training.

Subtitle C--Nationwide Program for National and State Background Checks 
  on Direct Patient Access Employees of Long-Term Care Facilities and 
                               Providers

Sec. 5201. Nationwide program for National and State background checks 
              on direct patient access employees of long-term care 
              facilities and providers.

             Subtitle D--Patient-Centered Outcomes Research

Sec. 5301. Patient-Centered Outcomes Research.

                     Subtitle F--Elder Justice Act

Sec. 5401. Short title of subtitle.
Sec. 5402. Definitions.
Sec. 5403. Elder Justice.

     Subtitle G--Sense of the Senate Regarding Medical Malpractice

Sec. 5501. Sense of the Senate regarding medical malpractice.

       TITLE VI--IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES

         Subtitle A--Biologics Price Competition and Innovation

Sec. 6001. Short title.
Sec. 6002. Approval pathway for biosimilar biological products.
Sec. 6003. Savings.

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

Sec. 6101. Expanded participation in 340B program.
Sec. 6102. Improvements to 340B program integrity.
Sec. 6103. GAO study to make recommendations on improving the 340B 
              program.

                   TITLE I--AMERICAN HEALTH SECURITY

     SEC. 1000. SHORT TITLE.

       This title may be cited as the ``American Health Security 
     Act of 2009''

  Subtitle A--Establishment of a State-Based American Health Security 
               Program; Universal Entitlement; Enrollment

     SEC. 1001. ESTABLISHMENT OF A STATE-BASED AMERICAN HEALTH 
                   SECURITY PROGRAM.

       (a) In General.--There is hereby established in the United 
     States a State-Based American Health Security Program to be 
     administered by the individual States in accordance with 
     Federal standards specified in, or established under, this 
     title.
       (b) State Health Security Programs.--In order for a State 
     to be eligible to receive payment under section 1504, a State 
     must establish a State health security program in accordance 
     with this title.
       (c) State Defined.--
       (1) In general.--In this title, subject to paragraph (2), 
     the term ``State'' means each of the 50 States and the 
     District of Columbia.
       (2) Election.--If the Governor of Puerto Rico, the Virgin 
     Islands, Guam, American Samoa, or the Northern Mariana 
     Islands certifies to the President that the legislature of 
     the Commonwealth or territory has enacted legislation 
     desiring that the Commonwealth or territory be included as a 
     State under the provisions of this title, such Commonwealth 
     or territory shall be included as a ``State'' under this 
     title beginning January 1 of the first year beginning 90 days 
     after the President receives the notification.

     SEC. 1002. UNIVERSAL ENTITLEMENT.

       (a) In General.--Every individual who is a resident of the 
     United States and is a citizen or national of the United 
     States or lawful resident alien (as defined in subsection 
     (d)) is entitled to benefits for health care services under 
     this title under the appropriate State health security 
     program. In this section, the term ``appropriate State health 
     security program'' means, with respect to an individual, the 
     State health security program for the State in which the 
     individual maintains a primary residence.
       (b) Treatment of Certain Nonimmigrants.--
       (1) In general.--The American Health Security Standards 
     Board (in this title referred to as the ``Board'') may make 
     eligible for benefits for health care services under the 
     appropriate State health security program under this title 
     such classes of aliens admitted to the United States as 
     nonimmigrants as the Board may provide.
       (2) Consideration.--In providing for eligibility under 
     paragraph (1), the Board shall consider reciprocity in health 
     care services offered to United States citizens who are 
     nonimmigrants in other foreign states, and such other factors 
     as the Board determines to be appropriate.
       (c) Treatment of Other Individuals.--
       (1) By board.--The Board also may make eligible for 
     benefits for health care services under the appropriate State 
     health security program under this title other individuals 
     not described in subsection (a) or (b), and regulate the 
     nature of the eligibility of such individuals, in order--
       (A) to preserve the public health of communities;
       (B) to compensate States for the additional health care 
     financing burdens created by such individuals; and
       (C) to prevent adverse financial and medical consequences 
     of uncompensated care,
     while inhibiting travel and immigration to the United States 
     for the sole purpose of obtaining health care services.
       (2) By states.--Any State health security program may make 
     individuals described in paragraph (1) eligible for benefits 
     at the expense of the State.
       (d) Lawful Resident Alien Defined.--For purposes of this 
     section, the term ``lawful

[[Page S12174]]

     resident alien'' means an alien lawfully admitted for 
     permanent residence and any other alien lawfully residing 
     permanently in the United States under color of law, 
     including an alien with lawful temporary resident status 
     under section 210, 210A, or 234A of the Immigration and 
     Nationality Act (8 U.S.C. 1160, 1161, or 1255a).

     SEC. 1003. ENROLLMENT.

       (a) In General.--Each State health security program shall 
     provide a mechanism for the enrollment of individuals 
     entitled or eligible for benefits under this title. The 
     mechanism shall--
       (1) include a process for the automatic enrollment of 
     individuals at the time of birth in the United States and at 
     the time of immigration into the United States or other 
     acquisition of lawful resident status in the United States;
       (2) provide for the enrollment, as of January 1, 2011, of 
     all individuals who are eligible to be enrolled as of such 
     date; and
       (3) include a process for the enrollment of individuals 
     made eligible for health care services under subsections (b) 
     and (c) of section 1002.
       (b) Availability of Applications.--Each State health 
     security program shall make applications for enrollment under 
     the program available--
       (1) at employment and payroll offices of employers located 
     in the State;
       (2) at local offices of the Social Security Administration;
       (3) at social services locations;
       (4) at out-reach sites (such as provider and practitioner 
     locations); and
       (5) at other locations (including post offices and schools) 
     accessible to a broad cross-section of individuals eligible 
     to enroll.
       (c) Issuance of Health Security Cards.--In conjunction with 
     an individual's enrollment for benefits under this title, the 
     State health security program shall provide for the issuance 
     of a health security card that shall be used for purposes of 
     identification and processing of claims for benefits under 
     the program. The State health security program may provide 
     for issuance of such cards by employers for purposes of 
     carrying out enrollment pursuant to subsection (a)(2).

     SEC. 1004. PORTABILITY OF BENEFITS.

       (a) In General.--To ensure continuous access to benefits 
     for health care services covered under this title, each State 
     health security program--
       (1) shall not impose any minimum period of residence in the 
     State, or waiting period, in excess of 3 months before 
     residents of the State are entitled to, or eligible for, such 
     benefits under the program;
       (2) shall provide continuation of payment for covered 
     health care services to individuals who have terminated their 
     residence in the State and established their residence in 
     another State, for the duration of any waiting period imposed 
     in the State of new residency for establishing entitlement 
     to, or eligibility for, such services; and
       (3) shall provide for the payment for health care services 
     covered under this title provided to individuals while 
     temporarily absent from the State based on the following 
     principles:
       (A) Payment for such health care services is at the rate 
     that is approved by the State health security program in the 
     State in which the services are provided, unless the States 
     concerned agree to apportion the cost between them in a 
     different manner.
       (B) Payment for such health care services provided outside 
     the United States is made on the basis of the amount that 
     would have been paid by the State health security program for 
     similar services rendered in the State, with due regard, in 
     the case of hospital services, to the size of the hospital, 
     standards of service, and other relevant factors.
       (b) Cross-Border Arrangements.--A State health security 
     program for a State may negotiate with such a program in an 
     adjacent State a reciprocal arrangement for the coverage 
     under such other program of health care services to enrollees 
     residing in the border region.

     SEC. 1005. EFFECTIVE DATE OF BENEFITS.

       Benefits shall first be available under this title for 
     items and services furnished on or after January 1, 2011.

     SEC. 1006. RELATIONSHIP TO EXISTING FEDERAL HEALTH PROGRAMS.

       (a) Medicare, Medicaid and State Children's Health 
     Insurance Program (SCHIP).--
       (1) In general.--Notwithstanding any other provision of 
     law, subject to paragraph (2)--
       (A) no benefits shall be available under title XVIII of the 
     Social Security Act for any item or service furnished after 
     December 31, 2010;
       (B) no individual is entitled to medical assistance under a 
     State plan approved under title XIX of such Act for any item 
     or service furnished after such date;
       (C) no individual is entitled to medical assistance under 
     an SCHIP plan under title XXI of such Act for any item or 
     service furnished after such date; and
       (D) no payment shall be made to a State under section 
     1903(a) or 2105(a) of such Act with respect to medical 
     assistance or child health assistance for any item or service 
     furnished after such date.
       (2) Transition.--In the case of inpatient hospital services 
     and extended care services during a continuous period of stay 
     which began before January 1, 2011, and which had not ended 
     as of such date, for which benefits are provided under title 
     XVIII, under a State plan under title XIX, or a State child 
     health plan under title XXI, of the Social Security Act, the 
     Secretary of Health and Human Services and each State plan, 
     respectively, shall provide for continuation of benefits 
     under such title or plan until the end of the period of stay.
       (b) Federal Employees Health Benefits Program.--No benefits 
     shall be made available under chapter 89 of title 5, United 
     States Code, for any part of a coverage period occurring 
     after December 31, 2010.
       (c) CHAMPUS.--No benefits shall be made available under 
     sections 1079 and 1086 of title 10, United States Code, for 
     items or services furnished after December 31, 2010.
       (d) Treatment of Benefits for Veterans and Native 
     Americans.--Nothing in this title shall affect the 
     eligibility of veterans for the medical benefits and services 
     provided under title 38, United States Code, or of Indians 
     for the medical benefits and services provided by or through 
     the Indian Health Service.

 Subtitle B--Comprehensive Benefits, Including Preventive Benefits and 
                      Benefits for Long-Term Care

     SEC. 1101. COMPREHENSIVE BENEFITS.

       (a) In General.--Subject to the succeeding provisions of 
     this title, individuals enrolled for benefits under this 
     title are entitled to have payment made under a State health 
     security program for the following items and services if 
     medically necessary or appropriate for the maintenance of 
     health or for the diagnosis, treatment, or rehabilitation of 
     a health condition:
       (1) Hospital services.--Inpatient and outpatient hospital 
     care, including 24-hour-a-day emergency services.
       (2) Professional services.--Professional services of health 
     care practitioners authorized to provide health care services 
     under State law, including patient education and training in 
     self-management techniques.
       (3) Community-based primary health services.--Community-
     based primary health services (as defined in section 
     1102(a)).
       (4) Preventive services.--Preventive services (as defined 
     in section 1102(b)).
       (5) Long-term, acute, and chronic care services.--
       (A) Nursing facility services.
       (B) Home health services.
       (C) Home and community-based long-term care services (as 
     defined in section 1102(c)) for individuals described in 
     section 1103(a).
       (D) Hospice care.
       (E) Services in intermediate care facilities for 
     individuals with mental retardation.
       (6) Prescription drugs, biologicals, insulin, medical 
     foods.--
       (A) Outpatient prescription drugs and biologics, as 
     specified by the Board consistent with section 1515.
       (B) Insulin.
       (C) Medical foods (as defined in section 1102(e)).
       (7) Dental services.--Dental services (as defined in 
     section 1102(h)).
       (8) Mental health and substance abuse treatment services.--
     Mental health and substance abuse treatment services (as 
     defined in section 1102(f)).
       (9) Diagnostic tests.--Diagnostic tests.
       (10) Other items and services.--
       (A) Outpatient therapy.--Outpatient physical therapy 
     services, outpatient speech pathology services, and 
     outpatient occupational therapy services in all settings.
       (B) Durable medical equipment.--Durable medical equipment.
       (C) Home dialysis.--Home dialysis supplies and equipment.
       (D) Ambulance.--Emergency ambulance service.
       (E) Prosthetic devices.--Prosthetic devices, including 
     replacements of such devices.
       (F) Additional items and services.--Such other medical or 
     health care items or services as the Board may specify.
       (b) Prohibition of Balance Billing.--No person may impose a 
     charge for covered services for which benefits are provided 
     under this title.
       (c) No Duplicate Health Insurance.--Each State health 
     security program shall prohibit the sale of health insurance 
     in the State if payment under the insurance duplicates 
     payment for any items or services for which payment may be 
     made under such a program.
       (d) State Program May Provide Additional Benefits.--Nothing 
     in this title shall be construed as limiting the benefits 
     that may be made available under a State health security 
     program to residents of the State at the expense of the 
     State.
       (e) Employers May Provide Additional Benefits.--Nothing in 
     this title shall be construed as limiting the additional 
     benefits that an employer may provide to employees or their 
     dependents, or to former employees or their dependents.

     SEC. 1102. DEFINITIONS RELATING TO SERVICES.

       (a) Community-Based Primary Health Services.--In this 
     title, the term ``community-based primary health services'' 
     means ambulatory health services furnished--
       (1) by a rural health clinic;
       (2) by a federally qualified health center (as defined in 
     section 1905(l)(2)(B) of the Social Security Act), and which, 
     for purposes of this title, include services furnished by 
     State and local health agencies;
       (3) in a school-based setting;
       (4) by public educational agencies and other providers of 
     services to children entitled to assistance under the 
     Individuals with

[[Page S12175]]

     Disabilities Education Act for services furnished pursuant to 
     a written Individualized Family Services Plan or Individual 
     Education Plan under such Act; and
       (5) public and private nonprofit entities receiving Federal 
     assistance under the Public Health Service Act.
       (b) Preventive Services.--
       (1) In general.--In this title, the term ``preventive 
     services'' means items and services--
       (A) which--
       (i) are specified in paragraph (2); or
       (ii) the Board determines to be effective in the 
     maintenance and promotion of health or minimizing the effect 
     of illness, disease, or medical condition; and
       (B) which are provided consistent with the periodicity 
     schedule established under paragraph (3).
       (2) Specified preventive services.--The services specified 
     in this paragraph are as follows:
       (A) Basic immunizations.
       (B) Prenatal and well-baby care (for infants under 1 year 
     of age).
       (C) Well-child care (including periodic physical 
     examinations, hearing and vision screening, and developmental 
     screening and examinations) for individuals under 18 years of 
     age.
       (D) Periodic screening mammography, Pap smears, and 
     colorectal examinations and examinations for prostate cancer.
       (E) Physical examinations.
       (F) Family planning services.
       (G) Routine eye examinations, eyeglasses, and contact 
     lenses.
       (H) Hearing aids, but only upon a determination of a 
     certified audiologist or physician that a hearing problem 
     exists and is caused by a condition that can be corrected by 
     use of a hearing aid.
       (3) Schedule.--The Board shall establish, in consultation 
     with experts in preventive medicine and public health and 
     taking into consideration those preventive services 
     recommended by the Preventive Services Task Force and 
     published as the Guide to Clinical Preventive Services, a 
     periodicity schedule for the coverage of preventive services 
     under paragraph (1). Such schedule shall take into 
     consideration the cost-effectiveness of appropriate 
     preventive care and shall be revised not less frequently than 
     once every 5 years, in consultation with experts in 
     preventive medicine and public health.
       (c) Home and Community-Based Long-Term Care Services.--In 
     this title, the term ``home and community-based long-term 
     care services'' means the following services provided to an 
     individual to enable the individual to remain in such 
     individual's place of residence within the community:
       (1) Home health aide services.
       (2) Adult day health care, social day care or psychiatric 
     day care.
       (3) Medical social work services.
       (4) Care coordination services, as defined in subsection 
     (g)(1).
       (5) Respite care, including training for informal 
     caregivers.
       (6) Personal assistance services, and homemaker services 
     (including meals) incidental to the provision of personal 
     assistance services.
       (d) Home Health Services.--
       (1) In general.--The term ``home health services'' means 
     items and services described in section 1861(m) of the Social 
     Security Act and includes home infusion services.
       (2) Home infusion services.--The term ``home infusion 
     services'' includes the nursing, pharmacy, and related 
     services that are necessary to conduct the home infusion of a 
     drug regimen safely and effectively under a plan established 
     and periodically reviewed by a physician and that are 
     provided in compliance with quality assurance requirements 
     established by the Secretary.
       (e) Medical Foods.--In this title, the term ``medical 
     foods'' means foods which are formulated to be consumed or 
     administered enterally under the supervision of a physician 
     and which are intended for the specific dietary management of 
     a disease or condition for which distinctive nutritional 
     requirements, based on recognized scientific principles, are 
     established by medical evaluation.
       (f) Mental Health and Substance Abuse Treatment Services.--
       (1) Services described.--In this title, the term ``mental 
     health and substance abuse treatment services'' means the 
     following services related to the prevention, diagnosis, 
     treatment, and rehabilitation of mental illness and promotion 
     of mental health:
       (A) Inpatient hospital services.--Inpatient hospital 
     services furnished primarily for the diagnosis or treatment 
     of mental illness or substance abuse for up to 60 days during 
     a year, reduced by a number of days determined by the 
     Secretary so that the actuarial value of providing such 
     number of days of services under this paragraph to the 
     individual is equal to the actuarial value of the days of 
     inpatient residential services furnished to the individual 
     under subparagraph (B) during the year after such services 
     have been furnished to the individual for 120 days during the 
     year (rounded to the nearest day), but only if (with respect 
     to services furnished to an individual described in section 
     1104(b)(1)) such services are furnished in conformity with 
     the plan of an organized system of care for mental health and 
     substance abuse services in accordance with section 
     1104(b)(2).
       (B) Intensive residential services.--Intensive residential 
     services (as defined in paragraph (2)) furnished to an 
     individual for up to 120 days during any calendar year, 
     except that--
       (i) such services may be furnished to the individual for 
     additional days during the year if necessary for the 
     individual to complete a course of treatment to the extent 
     that the number of days of inpatient hospital services 
     described in subparagraph (A) that may be furnished to the 
     individual during the year (as reduced under such 
     subparagraph) is not less than 15; and
       (ii) reduced by a number of days determined by the 
     Secretary so that the actuarial value of providing such 
     number of days of services under this paragraph to the 
     individual is equal to the actuarial value of the days of 
     intensive community-based services furnished to the 
     individual under subparagraph (D) during the year after such 
     services have been furnished to the individual for 90 days 
     (or, in the case of services described in subparagraph 
     (D)(ii), for 180 days) during the year (rounded to the 
     nearest day).
       (C) Outpatient services.--Outpatient treatment services of 
     mental illness or substance abuse (other than intensive 
     community-based services under subparagraph (D)) for an 
     unlimited number of days during any calendar year furnished 
     in accordance with standards established by the Secretary for 
     the management of such services, and, in the case of services 
     furnished to an individual described in section 1104(b)(1) 
     who is not an inpatient of a hospital, in conformity with the 
     plan of an organized system of care for mental health and 
     substance abuse services in accordance with section 
     1104(b)(2).
       (D) Intensive community-based services.--Intensive 
     community-based services (as described in paragraph (3))--
       (i) for an unlimited number of days during any calendar 
     year, in the case of services described in section 
     1861(ff)(2)(E) that are furnished to an individual who is a 
     seriously mentally ill adult, a seriously emotionally 
     disturbed child, or an adult or child with serious substance 
     abuse disorder (as determined in accordance with criteria 
     established by the Secretary);
       (ii) in the case of services described in section 
     1861(ff)(2)(C), for up to 180 days during any calendar year, 
     except that such services may be furnished to the individual 
     for a number of additional days during the year equal to the 
     difference between the total number of days of intensive 
     residential services which the individual may receive during 
     the year under part A (as determined under subparagraph (B)) 
     and the number of days of such services which the individual 
     has received during the year; or
       (iii) in the case of any other such services, for up to 90 
     days during any calendar year, except that such services may 
     be furnished to the individual for the number of additional 
     days during the year described in clause (ii).
       (2) Intensive residential services defined.--
       (A) In general.--Subject to subparagraphs (B) and (C), the 
     term ``intensive residential services'' means inpatient 
     services provided in any of the following facilities:
       (i) Residential detoxification centers.
       (ii) Crisis residential programs or mental illness 
     residential treatment programs.
       (iii) Therapeutic family or group treatment homes.
       (iv) Residential centers for substance abuse treatment.
       (B) Requirements for facilities.--No service may be treated 
     as an intensive residential service under subparagraph (A) 
     unless the facility at which the service is provided--
       (i) is legally authorized to provide such service under the 
     law of the State (or under a State regulatory mechanism 
     provided by State law) in which the facility is located or is 
     certified to provide such service by an appropriate 
     accreditation entity approved by the State in consultation 
     with the Secretary; and
       (ii) meets such other requirements as the Secretary may 
     impose to assure the quality of the intensive residential 
     services provided.
       (C) Services furnished to at-risk children.--In the case of 
     services furnished to an individual described in section 
     1104(b)(1), no service may be treated as an intensive 
     residential service under this subsection unless the service 
     is furnished in conformity with the plan of an organized 
     system of care for mental health and substance abuse services 
     in accordance with section 1104(b)(2).
       (D) Management standards.--No service may be treated as an 
     intensive residential service under subparagraph (A) unless 
     the service is furnished in accordance with standards 
     established by the Secretary for the management of such 
     services.
       (3) Intensive community-based services defined.--
       (A) In general.--The term ``intensive community-based 
     services'' means the items and services described in 
     subparagraph (B) prescribed by a physician (or, in the case 
     of services furnished to an individual described in section 
     1104(b)(1), by an organized system of care for mental health 
     and substance abuse services in accordance with such section) 
     and provided under a program described in subparagraph (D) 
     under the supervision of a physician (or, to the extent 
     permitted under the law of the State in which the services 
     are furnished, a non-physician mental health professional) 
     pursuant to an individualized, written plan of treatment 
     established and periodically reviewed by a physician (in 
     consultation with appropriate staff participating in such 
     program) which sets

[[Page S12176]]

     forth the physician's diagnosis, the type, amount, frequency, 
     and duration of the items and services provided under the 
     plan, and the goals for treatment under the plan, but does 
     not include any item or service that is not furnished in 
     accordance with standards established by the Secretary for 
     the management of such services.
       (B) Items and services described.--The items and services 
     described in this subparagraph are--
       (i) partial hospitalization services consisting of the 
     items and services described in subparagraph (C);
       (ii) psychiatric rehabilitation services;
       (iii) day treatment services for individuals under 19 years 
     of age;
       (iv) in-home services;
       (v) case management services, including collateral services 
     designated as such case management services by the Secretary;
       (vi) ambulatory detoxification services; and
       (vii) such other items and services as the Secretary may 
     provide (but in no event to include meals and 
     transportation),
     that are reasonable and necessary for the diagnosis or active 
     treatment of the individual's condition, reasonably expected 
     to improve or maintain the individual's condition and 
     functional level and to prevent relapse or hospitalization, 
     and furnished pursuant to such guidelines relating to 
     frequency and duration of services as the Secretary shall by 
     regulation establish (taking into account accepted norms of 
     medical practice and the reasonable expectation of patient 
     improvement).
       (C) Items and services included as partial hospitalization 
     services.--For purposes of subparagraph (B)(i), partial 
     hospitalization services consist of the following:
       (i) Individual and group therapy with physicians or 
     psychologists (or other mental health professionals to the 
     extent authorized under State law).
       (ii) Occupational therapy requiring the skills of a 
     qualified occupational therapist.
       (iii) Services of social workers, trained psychiatric 
     nurses, behavioral aides, and other staff trained to work 
     with psychiatric patients (to the extent authorized under 
     State law).
       (iv) Drugs and biologicals furnished for therapeutic 
     purposes (which cannot, as determined in accordance with 
     regulations, be self-administered).
       (v) Individualized activity therapies that are not 
     primarily recreational or diversionary.
       (vi) Family counseling (the primary purpose of which is 
     treatment of the individual's condition).
       (vii) Patient training and education (to the extent that 
     training and educational activities are closely and clearly 
     related to the individual's care and treatment).
       (viii) Diagnostic services.
       (D) Programs described.--A program described in this 
     subparagraph is a program (whether facility-based or 
     freestanding) which is furnished by an entity--
       (i) legally authorized to furnish such a program under 
     State law (or the State regulatory mechanism provided by 
     State law) or certified to furnish such a program by an 
     appropriate accreditation entity approved by the State in 
     consultation with the Secretary; and
       (ii) meeting such other requirements as the Secretary may 
     impose to assure the quality of the intensive community-based 
     services provided.
       (g) Care Coordination Services.--
       (1) In general.--In this title, the term ``care 
     coordination services'' means services provided by care 
     coordinators (as defined in paragraph (2)) to individuals 
     described in paragraph (3) for the coordination and 
     monitoring of home and community-based long term care 
     services to ensure appropriate, cost-effective utilization of 
     such services in a comprehensive and continuous manner, and 
     includes--
       (A) transition management between inpatient facilities and 
     community-based services, including assisting patients in 
     identifying and gaining access to appropriate ancillary 
     services; and
       (B) evaluating and recommending appropriate treatment 
     services, in cooperation with patients and other providers 
     and in conjunction with any quality review program or plan of 
     care under section 1105.
       (2) Care coordinator.--
       (A) In general.--In this title, the term ``care 
     coordinator'' means an individual or nonprofit or public 
     agency or organization which the State health security 
     program determines--
       (i) is capable of performing directly, efficiently, and 
     effectively the duties of a care coordinator described in 
     paragraph (1); and
       (ii) demonstrates capability in establishing and 
     periodically reviewing and revising plans of care, and in 
     arranging for and monitoring the provision and quality of 
     services under any plan.
       (B) Independence.--State health security programs shall 
     establish safeguards to assure that care coordinators have no 
     financial interest in treatment decisions or placements. Care 
     coordination may not be provided through any structure or 
     mechanism through which quality review is performed.
       (3) Eligible individuals.--An individual described in this 
     paragraph is an individual described in section 1103 
     (relating to individuals qualifying for long term and chronic 
     care services).
       (h) Dental Services.--
       (1) In general.--In this title, subject to subsection (b), 
     the term ``dental services'' means the following:
       (A) Emergency dental treatment, including extractions, for 
     bleeding, pain, acute infections, and injuries to the 
     maxillofacial region.
       (B) Prevention and diagnosis of dental disease, including 
     examinations of the hard and soft tissues of the oral cavity 
     and related structures, radiographs, dental sealants, 
     fluorides, and dental prophylaxis.
       (C) Treatment of dental disease, including non-cast 
     fillings, periodontal maintenance services, and endodontic 
     services.
       (D) Space maintenance procedures to prevent orthodontic 
     complications.
       (E) Orthodontic treatment to prevent severe malocclusions.
       (F) Full dentures.
       (G) Medically necessary oral health care.
       (H) Any items and services for special needs patients that 
     are not described in subparagraphs (A) through (G) and that--
       (i) are required to provide such patients the items and 
     services described in subparagraphs (A) through (G);
       (ii) are required to establish oral function (including 
     general anesthesia for individuals with physical or emotional 
     limitations that prevent the provision of dental care without 
     such anesthesia);
       (iii) consist of orthodontic care for severe dentofacial 
     abnormalities; or
       (iv) consist of prosthetic dental devices for genetic or 
     birth defects or fitting for such devices.
       (I) Any dental care for individuals with a seizure disorder 
     that is not described in subparagraphs (A) through (H) and 
     that is required because of an illness, injury, disorder, or 
     other health condition that results from such seizure 
     disorder.
       (2) Limitations.--Dental services are subject to the 
     following limitations:
       (A) Prevention and diagnosis.--
       (i) Examinations and prophylaxis.--The examinations and 
     prophylaxis described in paragraph (1)(B) are covered only 
     consistent with a periodicity schedule established by the 
     Board, which schedule may provide for special treatment of 
     individuals less than 18 years of age and of special needs 
     patients.
       (ii) Dental sealants.--The dental sealants described in 
     such paragraph are not covered for individuals 18 years of 
     age or older. Such sealants are covered for individuals less 
     than 10 years of age for protection of the 1st permanent 
     molars. Such sealants are covered for individuals 10 years of 
     age or older for protection of the 2d permanent molars.
       (B) Treatment of dental disease.--Prior to January 1, 2016, 
     the items and services described in paragraph (1)(C) are 
     covered only for individuals less than 18 years of age and 
     special needs patients. On or after such date, such items and 
     services are covered for all individuals enrolled for 
     benefits under this title, except that endodontic services 
     are not covered for individuals 18 years of age or older.
       (C) Space maintenance.--The items and services described in 
     paragraph (1)(D) are covered only for individuals at least 3 
     years of age, but less than 13 years of age and--
       (i) are limited to posterior teeth;
       (ii) involve maintenance of a space or spaces for permanent 
     posterior teeth that would otherwise be prevented from normal 
     eruption if the space were not maintained; and
       (iii) do not include a space maintainer that is placed 
     within 6 months of the expected eruption of the permanent 
     posterior tooth concerned.
       (3) Definitions.--For purposes of this title:
       (A) Medically necessary oral health care.--The term 
     ``medically necessary oral health care'' means oral health 
     care that is required as a direct result of, or would have a 
     direct impact on, an underlying medical condition. Such term 
     includes oral health care directed toward control or 
     elimination of pain, infection, or reestablishment of oral 
     function.
       (B) Special needs patient.--The term ``special needs 
     patient'' includes an individual with a genetic or birth 
     defect, a developmental disability, or an acquired medical 
     disability.
       (i) Nursing Facility; Nursing Facility Services.--Except as 
     may be provided by the Board, the terms ``nursing facility'' 
     and ``nursing facility services'' have the meanings given 
     such terms in sections 1919(a) and 1905(f), respectively, of 
     the Social Security Act.
       (j) Services in Intermediate Care Facilities for 
     Individuals With Mental Retardation.--Except as may be 
     provided by the Board--
       (1) the term ``intermediate care facility for individuals 
     with mental retardation'' has the meaning specified in 
     section 1905(d) of the Social Security Act (as in effect 
     before the enactment of this title); and
       (2) the term ``services in intermediate care facilities for 
     individuals with mental retardation'' means services 
     described in section 1905(a)(15) of such Act (as so in 
     effect) in an intermediate care facility for individuals with 
     mental retardation to an individual determined to require 
     such services in accordance with standards specified by the 
     Board and comparable to the standards described in section 
     1902(a)(31)(A) of such Act (as so in effect).
       (k) Other Terms.--Except as may be provided by the Board, 
     the definitions contained in section 1861 of the Social 
     Security Act shall apply.

[[Page S12177]]

     SEC. 1103. SPECIAL RULES FOR HOME AND COMMUNITY-BASED LONG-
                   TERM CARE SERVICES.

       (a) Qualifying Individuals.--For purposes of section 
     1101(a)(5)(C), individuals described in this subsection are 
     the following individuals:
       (1) Adults.--Individuals 18 years of age or older 
     determined (in a manner specified by the Board)--
       (A) to be unable to perform, without the assistance of an 
     individual, at least 2 of the following 5 activities of daily 
     living (or who has a similar level of disability due to 
     cognitive impairment)--
       (i) bathing;
       (ii) eating;
       (iii) dressing;
       (iv) toileting; and
       (v) transferring in and out of a bed or in and out of a 
     chair;
       (B) due to cognitive or mental impairments, to require 
     supervision because the individual behaves in a manner that 
     poses health or safety hazards to himself or herself or 
     others; or
       (C) due to cognitive or mental impairments, to require 
     queuing to perform activities of daily living.
       (2) Children.--Individuals under 18 years of age determined 
     (in a manner specified by the Board) to meet such alternative 
     standard of disability for children as the Board develops. 
     Such alternative standard shall be comparable to the standard 
     for adults and appropriate for children.
       (b) Limit on Services.--
       (1) In general.--The aggregate expenditures by a State 
     health security program with respect to home and community-
     based long-term care services in a period (specified by the 
     Board) may not exceed 65 percent (or such alternative ratio 
     as the Board establishes under paragraph (2)) of the average 
     of the amount of payment that would have been made under the 
     program during the period if all the home-based long-term 
     care beneficiaries had been residents of nursing facilities 
     in the same area in which the services were provided.
       (2) Alternative ratio.--The Board may establish for 
     purposes of paragraph (1) an alternative ratio (of payments 
     for home and community-based long term care services to 
     payments for nursing facility services) as the Board 
     determines to be more consistent with the goal of providing 
     cost-effective long-term care in the most appropriate and 
     least restrictive setting.

     SEC. 1104. EXCLUSIONS AND LIMITATIONS.

       (a) In General.--Subject to section 1101(e), benefits for 
     service are not available under this title unless the 
     services meet the standards specified in section 1101(a).
       (b) Special Delivery Requirements for Mental Health and 
     Substance Abuse Treatment Services Provided to At-Risk 
     Children.--
       (1) Requiring services to be provided through organized 
     systems of care.--A State health security program shall 
     ensure that mental health services and substance abuse 
     treatment services are furnished through an organized system 
     of care, as described in paragraph (2), if--
       (A) the services are provided to an individual less than 22 
     years of age;
       (B) the individual has a serious emotional disturbance or a 
     substance abuse disorder; and
       (C) the individual is, or is at imminent risk of being, 
     subject to the authority of, or in need of the services of, 
     at least 1 public agency that serves the needs of children, 
     including an agency involved with child welfare, special 
     education, juvenile justice, or criminal justice.
       (2) Requirements for system of care.--In this subsection, 
     an ``organized system of care'' is a community-based service 
     delivery network, which may consist of public and private 
     providers, that meets the following requirements:
       (A) The system has established linkages with existing 
     mental health services and substance abuse treatment service 
     delivery programs in the plan service area (or is in the 
     process of developing or operating a system with appropriate 
     public agencies in the area to coordinate the delivery of 
     such services to individuals in the area).
       (B) The system provides for the participation and 
     coordination of multiple agencies and providers that serve 
     the needs of children in the area, including agencies and 
     providers involved with child welfare, education, juvenile 
     justice, criminal justice, health care, mental health, and 
     substance abuse prevention and treatment.
       (C) The system provides for the involvement of the families 
     of children to whom mental health services and substance 
     abuse treatment services are provided in the planning of 
     treatment and the delivery of services.
       (D) The system provides for the development and 
     implementation of individualized treatment plans by 
     multidisciplinary and multiagency teams, which are recognized 
     and followed by the applicable agencies and providers in the 
     area.
       (E) The system ensures the delivery and coordination of the 
     range of mental health services and substance abuse treatment 
     services required by individuals under 22 years of age who 
     have a serious emotional disturbance or a substance abuse 
     disorder.
       (F) The system provides for the management of the 
     individualized treatment plans described in subparagraph (D) 
     and for a flexible response to changes in treatment needs 
     over time.
       (c) Treatment of Experimental Services.--In applying 
     subsection (a), the Board shall make national coverage 
     determinations with respect to those services that are 
     experimental in nature. Such determinations shall be made 
     consistent with a process that provides for input from 
     representatives of health care professionals and patients and 
     public comment.
       (d) Application of Practice Guidelines.--In the case of 
     services for which the American Health Security Quality 
     Council (established under section 1401) has recognized a 
     national practice guideline, the services are considered to 
     meet the standards specified in section 1101(a) if they have 
     been provided in accordance with such guideline or in 
     accordance with such guidelines as are provided by the State 
     health security program consistent with subtitle E. For 
     purposes of this subsection, a service shall be considered to 
     have been provided in accordance with a practice guideline if 
     the health care provider providing the service exercised 
     appropriate professional discretion to deviate from the 
     guideline in a manner authorized or anticipated by the 
     guideline.
       (e) Specific Limitations.--
       (1) Limitations on eyeglasses, contact lenses, hearing 
     aids, and durable medical equipment.--Subject to section 
     1101(e), the Board may impose such limits relating to the 
     costs and frequency of replacement of eyeglasses, contact 
     lenses, hearing aids, and durable medical equipment to which 
     individuals enrolled for benefits under this title are 
     entitled to have payment made under a State health security 
     program as the Board deems appropriate.
       (2) Overlap with preventive services.--The coverage of 
     services described in section 1101(a) (other than paragraph 
     (3)) which also are preventive services are required to be 
     covered only to the extent that they are required to be 
     covered as preventive services.
       (3) Miscellaneous exclusions from covered services.--
     Covered services under this title do not include the 
     following:
       (A) Surgery and other procedures (such as orthodontia) 
     performed solely for cosmetic purposes (as defined in 
     regulations) and hospital or other services incident thereto, 
     unless--
       (i) required to correct a congenital anomaly;
       (ii) required to restore or correct a part of the body 
     which has been altered as a result of accidental injury, 
     disease, or surgery; or
       (iii) otherwise determined to be medically necessary and 
     appropriate under section 1101(a).
       (B) Personal comfort items or private rooms in inpatient 
     facilities, unless determined to be medically necessary and 
     appropriate under section 1101(a).
       (C) The services of a professional practitioner if they are 
     furnished in a hospital or other facility which is not a 
     participating provider.
       (f) Nursing Facility Services and Home Health Services.--
     Nursing facility services and home health services (other 
     than post-hospital services, as defined by the Board) 
     furnished to an individual who is not described in section 
     1103(a) are not covered services unless the services are 
     determined to meet the standards specified in section 1101(a) 
     and, with respect to nursing facility services, to be 
     provided in the least restrictive and most appropriate 
     setting.

     SEC. 1105. CERTIFICATION; QUALITY REVIEW; PLANS OF CARE.

       (a) Certifications.--State health security programs may 
     require, as a condition of payment for institutional health 
     care services and other services of the type described in 
     such sections 1814(a) and 1835(a) of the Social Security Act, 
     periodic professional certifications of the kind described in 
     such sections.
       (b) Quality Review.--For requirement that each State health 
     security program establish a quality review program that 
     meets the requirements for such a program under subtitle E, 
     see section 1304(b)(1)(H).
       (c) Plan of Care Requirements.--A State health security 
     program may require, consistent with standards established by 
     the Board, that payment for services exceeding specified 
     levels or duration be provided only as consistent with a plan 
     of care or treatment formulated by one or more providers of 
     the services or other qualified professionals. Such a plan 
     may include, consistent with subsection (b), case management 
     at specified intervals as a further condition of payment for 
     services.

                   Subtitle C--Provider Participation

     SEC. 1201. PROVIDER PARTICIPATION AND STANDARDS.

       (a) In General.--An individual or other entity furnishing 
     any covered service under a State health security program 
     under this title is not a qualified provider unless the 
     individual or entity--
       (1) is a qualified provider of the services under section 
     1202;
       (2) has filed with the State health security program a 
     participation agreement described in subsection (b); and
       (3) meets such other qualifications and conditions as are 
     established by the Board or the State health security program 
     under this title.
       (b) Requirements in Participation Agreement.--
       (1) In general.--A participation agreement described in 
     this subsection between a State health security program and a 
     provider shall provide at least for the following:

[[Page S12178]]

       (A) Services to eligible persons will be furnished by the 
     provider without discrimination on the ground of race, 
     national origin, income, religion, age, sex or sexual 
     orientation, disability, handicapping condition, or (subject 
     to the professional qualifications of the provider) illness. 
     Nothing in this subparagraph shall be construed as requiring 
     the provision of a type or class of services which services 
     are outside the scope of the provider's normal practice.
       (B) No charge will be made for any covered services other 
     than for payment authorized by this title.
       (C) The provider agrees to furnish such information as may 
     be reasonably required by the Board or a State health 
     security program, in accordance with uniform reporting 
     standards established under section 1301(g)(1), for--
       (i) quality review by designated entities;
       (ii) the making of payments under this title (including the 
     examination of records as may be necessary for the 
     verification of information on which payments are based);
       (iii) statistical or other studies required for the 
     implementation of this title; and
       (iv) such other purposes as the Board or State may specify.
       (D) The provider agrees not to bill the program for any 
     services for which benefits are not available because of 
     section 1104(d).
       (E) In the case of a provider that is not an individual, 
     the provider agrees not to employ or use for the provision of 
     health services any individual or other provider who or which 
     has had a participation agreement under this subsection 
     terminated for cause.
       (F) In the case of a provider paid under a fee-for-service 
     basis under section 1511, the provider agrees to submit bills 
     and any required supporting documentation relating to the 
     provision of covered services within 30 days (or such shorter 
     period as a State health security program may require) after 
     the date of providing such services.
       (2) Termination of participation agreements.--
       (A) In general.--Participation agreements may be 
     terminated, with appropriate notice--
       (i) by the Board or a State health security program for 
     failure to meet the requirements of this title; or
       (ii) by a provider.
       (B) Termination process.--Providers shall be provided 
     notice and a reasonable opportunity to correct deficiencies 
     before the Board or a State health security program 
     terminates an agreement unless a more immediate termination 
     is required for public safety or similar reasons.

     SEC. 1202. QUALIFICATIONS FOR PROVIDERS.

       (a) In General.--A health care provider is considered to be 
     qualified to provide covered services if the provider is 
     licensed or certified and meets--
       (1) all the requirements of State law to provide such 
     services;
       (2) applicable requirements of Federal law to provide such 
     services; and
       (3) any applicable standards established under subsection 
     (b).
       (b) Minimum Provider Standards.--
       (1) In general.--The Board shall establish, evaluate, and 
     update national minimum standards to assure the quality of 
     services provided under this title and to monitor efforts by 
     State health security programs to assure the quality of such 
     services. A State health security program may also establish 
     additional minimum standards which providers must meet.
       (2) National minimum standards.--The national minimum 
     standards under paragraph (1) shall be established for 
     institutional providers of services, individual health care 
     practitioners, and comprehensive health service 
     organizations. Except as the Board may specify in order to 
     carry out this title, a hospital, nursing facility, or other 
     institutional provider of services shall meet standards for 
     such a facility under the medicare program under title XVIII 
     of the Social Security Act. Such standards also may include, 
     where appropriate, elements relating to--
       (A) adequacy and quality of facilities;
       (B) training and competence of personnel (including 
     continuing education requirements);
       (C) comprehensiveness of service;
       (D) continuity of service;
       (E) patient satisfaction (including waiting time and access 
     to services); and
       (F) performance standards (including organization, 
     facilities, structure of services, efficiency of operation, 
     and outcome in palliation, improvement of health, 
     stabilization, cure, or rehabilitation).
       (3) Transition in application.--If the Board provides for 
     additional requirements for providers under this subsection, 
     any such additional requirement shall be implemented in a 
     manner that provides for a reasonable period during which a 
     previously qualified provider is permitted to meet such an 
     additional requirement.
       (4) Exchange of information.--The Board shall provide for 
     an exchange, at least annually, among State health security 
     programs of information with respect to quality assurance and 
     cost containment.

     SEC. 1203. QUALIFICATIONS FOR COMPREHENSIVE HEALTH SERVICE 
                   ORGANIZATIONS.

       (a) In General.--For purposes of this title, a 
     comprehensive health service organization (in this section 
     referred to as a ``CHSO'') is a public or private 
     organization which, in return for a capitated payment amount, 
     undertakes to furnish, arrange for the provision of, or 
     provide payment with respect to--
       (1) a full range of health services (as identified by the 
     Board), including at least hospital services and physicians 
     services; and
       (2) out-of-area coverage in the case of urgently needed 
     services;

     to an identified population which is living in or near a 
     specified service area and which enrolls voluntarily in the 
     organization.
       (b) Enrollment.--
       (1) In general.--All eligible persons living in or near the 
     specified service area of a CHSO are eligible to enroll in 
     the organization; except that the number of enrollees may be 
     limited to avoid overtaxing the resources of the 
     organization.
       (2) Minimum enrollment period.--Subject to paragraph (3), 
     the minimum period of enrollment with a CHSO shall be twelve 
     months, unless the enrolled individual becomes ineligible to 
     enroll with the organization.
       (3) Withdrawal for cause.--Each CHSO shall permit an 
     enrolled individual to disenroll from the organization for 
     cause at any time.
       (c) Requirements for CHSOs.--
       (1) Accessible services.--Each CHSO, to the maximum extent 
     feasible, shall make all services readily and promptly 
     accessible to enrollees who live in the specified service 
     area.
       (2) Continuity of care.--Each CHSO shall furnish services 
     in such manner as to provide continuity of care and (when 
     services are furnished by different providers) shall provide 
     ready referral of patients to such services and at such times 
     as may be medically appropriate.
       (3) Board of directors.--In the case of a CHSO that is a 
     private organization--
       (A) Consumer representation.--At least one-third of the 
     members of the CHSO's board of directors must be consumer 
     members with no direct or indirect, personal or family 
     financial relationship to the organization.
       (B) Provider representation.--The CHSO's board of directors 
     must include at least one member who represents health care 
     providers.
       (4) Patient grievance program.--Each CHSO must have in 
     effect a patient grievance program and must conduct regularly 
     surveys of the satisfaction of members with services provided 
     by or through the organization.
       (5) Medical standards.--Each CHSO must provide that a 
     committee or committees of health care practitioners 
     associated with the organization will promulgate medical 
     standards, oversee the professional aspects of the delivery 
     of care, perform the functions of a pharmacy and drug 
     therapeutics committee, and monitor and review the quality of 
     all health services (including drugs, education, and 
     preventive services).
       (6) Premiums.--Premiums or other charges by a CHSO for any 
     services not paid for under this title must be reasonable.
       (7) Utilization and bonus information.--Each CHSO must--
       (A) comply with the requirements of section 1876(i)(8) of 
     the Social Security Act (relating to prohibiting physician 
     incentive plans that provide specific inducements to reduce 
     or limit medically necessary services); and
       (B) make available to its membership utilization 
     information and data regarding financial performance, 
     including bonus or incentive payment arrangements to 
     practitioners.
       (8) Provision of services to enrollees at institutions 
     operating under global budgets.--The organization shall 
     arrange to reimburse for hospital services and other 
     facility-based services (as identified by the Board) for 
     services provided to members of the organization in 
     accordance with the global operating budget of the hospital 
     or facility approved under section 1510.
       (9) Broad marketing.--Each CHSO must provide for the 
     marketing of its services (including dissemination of 
     marketing materials) to potential enrollees in a manner that 
     is designed to enroll individuals representative of the 
     different population groups and geographic areas included 
     within its service area and meets such requirements as the 
     Board or a State health security program may specify.
       (10) Additional requirements.--Each CHSO must meet--
       (A) such requirements relating to minimum enrollment;
       (B) such requirements relating to financial solvency;
       (C) such requirements relating to quality and availability 
     of care; and
       (D) such other requirements,

     as the Board or a State health security program may specify.
       (d) Provision of Emergency Services to Nonenrollees.--A 
     CHSO may furnish emergency services to persons who are not 
     enrolled in the organization. Payment for such services, if 
     they are covered services to eligible persons, shall be made 
     to the organization unless the organization requests that it 
     be made to the individual provider who furnished the 
     services.

     SEC. 1204. LIMITATION ON CERTAIN PHYSICIAN REFERRALS.

       (a) Application to American Health Security Program.--
     Section 1877 of the Social Security Act, as amended by 
     subsections (b) and (c), shall apply under this title in the 
     same manner as it applies under title XVIII of the Social 
     Security Act; except that in applying such section under this 
     title any references in such section to the Secretary or

[[Page S12179]]

     title XVIII of the Social Security Act are deemed references 
     to the Board and the American Health Security Program under 
     this title, respectively.
       (b) Expansion of Prohibition to Certain Additional 
     Designated Services.--Section 1877(h)(6) of the Social 
     Security Act (42 U.S.C. 1395nn(h)(6)) is amended by adding at 
     the end the following:
       ``(M) Ambulance services.
       ``(N) Home infusion therapy services.''.
       (c) Conforming Amendments.--Section 1877 of such Act is 
     further amended--
       (1) in subsection (a)(1)(A), by striking ``for which 
     payment otherwise may be made under this title'' and 
     inserting ``for which a charge is imposed'';
       (2) in subsection (a)(1)(B), by striking ``under this 
     title'';
       (3) by amending paragraph (1) of subsection (g) to read as 
     follows:
       ``(1) Denial of payment.--No payment may be made under a 
     State health security program for a designated health service 
     for which a claim is presented in violation of subsection 
     (a)(1)(B). No individual, third party payor, or other entity 
     is liable for payment for designated health services for 
     which a claim is presented in violation of such 
     subsection.''; and
       (4) in subsection (g)(3), by striking ``for which payment 
     may not be made under paragraph (1)'' and inserting ``for 
     which such a claim may not be presented under subsection 
     (a)(1)''.

                       Subtitle D--Administration

               PART I--GENERAL ADMINISTRATIVE PROVISIONS

     SEC. 1301. AMERICAN HEALTH SECURITY STANDARDS BOARD.

       (a) Establishment.--There is hereby established an American 
     Health Security Standards Board.
       (b) Appointment and Terms of Members.--
       (1) In general.--The Board shall be composed of--
       (A) the Secretary of Health and Human Services; and
       (B) 6 other individuals (described in paragraph (2)) 
     appointed by the President with the advice and consent of the 
     Senate.

     The President shall first nominate individuals under 
     subparagraph (B) on a timely basis so as to provide for the 
     operation of the Board by not later than January 1, 2010.
       (2) Selection of appointed members.--With respect to the 
     individuals appointed under paragraph (1)(B):
       (A) They shall be chosen on the basis of backgrounds in 
     health policy, health economics, the healing professions, and 
     the administration of health care institutions.
       (B) They shall provide a balanced point of view with 
     respect to the various health care interests and at least 2 
     of them shall represent the interests of individual 
     consumers.
       (C) Not more than 3 of them shall be from the same 
     political party.
       (D) To the greatest extent feasible, they shall represent 
     the various geographic regions of the United States and shall 
     reflect the racial, ethnic, and gender composition of the 
     population of the United States.
       (3) Terms of appointed members.--Individuals appointed 
     under paragraph (1)(B) shall serve for a term of 6 years, 
     except that the terms of 5 of the individuals initially 
     appointed shall be, as designated by the President at the 
     time of their appointment, for 1, 2, 3, 4, and 5 years. 
     During a term of membership on the Board, no member shall 
     engage in any other business, vocation or employment.
       (c) Vacancies.--
       (1) In general.--The President shall fill any vacancy in 
     the membership of the Board in the same manner as the 
     original appointment. The vacancy shall not affect the power 
     of the remaining members to execute the duties of the Board.
       (2) Vacancy appointments.--Any member appointed to fill a 
     vacancy shall serve for the remainder of the term for which 
     the predecessor of the member was appointed.
       (3) Reappointment.--The President may reappoint an 
     appointed member of the Board for a second term in the same 
     manner as the original appointment. A member who has served 
     for 2 consecutive 6-year terms shall not be eligible for 
     reappointment until 2 years after the member has ceased to 
     serve.
       (4) Removal for cause.--Upon confirmation, members of the 
     Board may not be removed except by the President for cause.
       (d) Chair.--The President shall designate 1 of the members 
     of the Board, other than the Secretary, to serve at the will 
     of the President as Chair of the Board.
       (e) Compensation.--Members of the Board (other than the 
     Secretary) shall be entitled to compensation at a level 
     equivalent to level II of the Executive Schedule, in 
     accordance with section 5313 of title 5, United States Code.
       (f) General Duties of the Board.--
       (1) In general.--The Board shall develop policies, 
     procedures, guidelines, and requirements to carry out this 
     title, including those related to--
       (A) eligibility;
       (B) enrollment;
       (C) benefits;
       (D) provider participation standards and qualifications, as 
     defined in subtitle C;
       (E) national and State funding levels;
       (F) methods for determining amounts of payments to 
     providers of covered services, consistent with part II of 
     subtitle D;
       (G) the determination of medical necessity and 
     appropriateness with respect to coverage of certain services;
       (H) assisting State health security programs with planning 
     for capital expenditures and service delivery;
       (I) planning for health professional education funding (as 
     specified in subtitle E); and
       (J) encouraging States to develop regional planning 
     mechanisms (described in section 1304(a)(3)).
       (2) Regulations.--Regulations authorized by this title 
     shall be issued by the Board in accordance with the 
     provisions of section 553 of title 5, United States Code.
       (g) Uniform Reporting Standards; Annual Report; Studies.--
       (1) Uniform reporting standards.--
       (A) In general.--The Board shall establish uniform 
     reporting requirements and standards to ensure an adequate 
     national data base regarding health services practitioners, 
     services and finances of State health security programs, 
     approved plans, providers, and the costs of facilities and 
     practitioners providing services. Such standards shall 
     include, to the maximum extent feasible, health outcome 
     measures.
       (B) Reports.--The Board shall analyze regularly information 
     reported to it, and to State health security programs 
     pursuant to such requirements and standards.
       (2) Annual report.--Beginning January 1, of the second year 
     beginning after the date of the enactment of this title, the 
     Board shall annually report to Congress on the following:
       (A) The status of implementation of the Act.
       (B) Enrollment under this title.
       (C) Benefits under this title.
       (D) Expenditures and financing under this title.
       (E) Cost-containment measures and achievements under this 
     title.
       (F) Quality assurance.
       (G) Health care utilization patterns, including any changes 
     attributable to the program.
       (H) Long-range plans and goals for the delivery of health 
     services.
       (I) Differences in the health status of the populations of 
     the different States, including income and racial 
     characteristics.
       (J) Necessary changes in the education of health personnel.
       (K) Plans for improving service to medically underserved 
     populations.
       (L) Transition problems as a result of implementation of 
     this title.
       (M) Opportunities for improvements under this title.
       (3) Statistical analyses and other studies.--The Board may, 
     either directly or by contract--
       (A) make statistical and other studies, on a nationwide, 
     regional, state, or local basis, of any aspect of the 
     operation of this title, including studies of the effect of 
     the Act upon the health of the people of the United States 
     and the effect of comprehensive health services upon the 
     health of persons receiving such services;
       (B) develop and test methods of providing through payment 
     for services or otherwise, additional incentives for 
     adherence by providers to standards of adequacy, access, and 
     quality; methods of consumer and peer review and peer control 
     of the utilization of drugs, of laboratory services, and of 
     other services; and methods of consumer and peer review of 
     the quality of services;
       (C) develop and test, for use by the Board, records and 
     information retrieval systems and budget systems for health 
     services administration, and develop and test model systems 
     for use by providers of services;
       (D) develop and test, for use by providers of services, 
     records and information retrieval systems useful in the 
     furnishing of preventive or diagnostic services;
       (E) develop, in collaboration with the pharmaceutical 
     profession, and test, improved administrative practices or 
     improved methods for the reimbursement of independent 
     pharmacies for the cost of furnishing drugs as a covered 
     service; and
       (F) make such other studies as it may consider necessary or 
     promising for the evaluation, or for the improvement, of the 
     operation of this title.
       (4) Report on use of existing federal health care 
     facilities.--Not later than 1 year after the date of the 
     enactment of this title, the Board shall recommend to the 
     Congress one or more proposals for the treatment of health 
     care facilities of the Federal Government.
       (h) Executive Director.--
       (1) Appointment.--There is hereby established the position 
     of Executive Director of the Board. The Director shall be 
     appointed by the Board and shall serve as secretary to the 
     Board and perform such duties in the administration of this 
     subtitle as the Board may assign.
       (2) Delegation.--The Board is authorized to delegate to the 
     Director or to any other officer or employee of the Board or, 
     with the approval of the Secretary of Health and Human 
     Services (and subject to reimbursement of identifiable 
     costs), to any other officer or employee of the Department of 
     Health and Human Services, any of its functions or duties 
     under this title other than--
       (A) the issuance of regulations; or
       (B) the determination of the availability of funds and 
     their allocation to implement this title.
       (3) Compensation.--The Executive Director of the Board 
     shall be entitled to compensation at a level equivalent to 
     level III of the

[[Page S12180]]

     Executive Schedule, in accordance with section 5314 of title 
     5, United States Code.
       (i) Inspector General.--The Inspector General Act of 1978 
     (5 U.S.C. App.) is amended--
       (1) in section 12(1), by inserting after ``Corporation;'' 
     the first place it appears the following: ``the Chair of the 
     American Health Security Standards Board;'';
       (2) in section 12(2), by inserting after ``Resolution Trust 
     Corporation,'' the following: ``the American Health Security 
     Standards Board,''; and
       (3) by inserting before section 9 the following:


  ``special provisions concerning american health security standards 
                                 board

       ``Sec. 8M.  The Inspector General of the American Health 
     Security Standards Board, in addition to the other 
     authorities vested by this Act, shall have the same 
     authority, with respect to the Board and the American Health 
     Security Program under this Act, as the Inspector General for 
     the Department of Health and Human Services has with respect 
     to the Secretary of Health and Human Services and the 
     medicare and medicaid programs, respectively.''.
       (j) Staff.--The Board shall employ such staff as the Board 
     may deem necessary.
       (k) Access to Information.--The Secretary of Health and 
     Human Services shall make available to the Board all 
     information available from sources within the Department or 
     from other sources, pertaining to the duties of the Board.

     SEC. 1302. AMERICAN HEALTH SECURITY ADVISORY COUNCIL.

       (a) In General.--The Board shall provide for an American 
     Health Security Advisory Council (in this section referred to 
     as the ``Council'') to advise the Board on its activities.
       (b) Membership.--The Council shall be composed of--
       (1) the Chair of the Board, who shall serve as Chair of the 
     Council; and
       (2) twenty members, not otherwise in the employ of the 
     United States, appointed by the Board without regard to the 
     provisions of title 5, United States Code, governing 
     appointments in the competitive service.

     The appointed members shall include, in accordance with 
     subsection (e), individuals who are representative of State 
     health security programs, public health professionals, 
     providers of health services, and of individuals (who shall 
     constitute a majority of the Council) who are representative 
     of consumers of such services, including a balanced 
     representation of employers, unions, consumer organizations, 
     and population groups with special health care needs. To the 
     greatest extent feasible, the membership of the Council shall 
     represent the various geographic regions of the United States 
     and shall reflect the racial, ethnic, and gender composition 
     of the population of the United States.
       (c) Terms of Members.--Each appointed member shall hold 
     office for a term of 4 years, except that--
       (1) any member appointed to fill a vacancy occurring during 
     the term for which the member's predecessor was appointed 
     shall be appointed for the remainder of that term; and
       (2) the terms of the members first taking office shall 
     expire, as designated by the Board at the time of 
     appointment, 5 at the end of the first year, 5 at the end of 
     the second year, 5 at the end of the third year, and 5 at the 
     end of the fourth year after the date of enactment of this 
     Act.
       (d) Vacancies.--
       (1) In general.--The Board shall fill any vacancy in the 
     membership of the Council in the same manner as the original 
     appointment. The vacancy shall not affect the power of the 
     remaining members to execute the duties of the Council.
       (2) Vacancy appointments.--Any member appointed to fill a 
     vacancy shall serve for the remainder of the term for which 
     the predecessor of the member was appointed.
       (3) Reappointment.--The Board may reappoint an appointed 
     member of the Council for a second term in the same manner as 
     the original appointment.
       (e) Qualifications.--
       (1) Public health representatives.--Members of the Council 
     who are representative of State health security programs and 
     public health professionals shall be individuals who have 
     extensive experience in the financing and delivery of care 
     under public health programs.
       (2) Providers.--Members of the Council who are 
     representative of providers of health care shall be 
     individuals who are outstanding in fields related to medical, 
     hospital, or other health activities, or who are 
     representative of organizations or associations of 
     professional health practitioners.
       (3) Consumers.--Members who are representative of consumers 
     of such care shall be individuals, not engaged in and having 
     no financial interest in the furnishing of health services, 
     who are familiar with the needs of various segments of the 
     population for personal health services and are experienced 
     in dealing with problems associated with the consumption of 
     such services.
       (f) Duties.--
       (1) In general.--It shall be the duty of the Council--
       (A) to advise the Board on matters of general policy in the 
     administration of this title, in the formulation of 
     regulations, and in the performance of the Board's duties 
     under section 1301; and
       (B) to study the operation of this title and the 
     utilization of health services under it, with a view to 
     recommending any changes in the administration of the Act or 
     in its provisions which may appear desirable.
       (2) Report.--The Council shall make an annual report to the 
     Board on the performance of its functions, including any 
     recommendations it may have with respect thereto, and the 
     Board shall promptly transmit the report to the Congress, 
     together with a report by the Board on any recommendations of 
     the Council that have not been followed.
       (g) Staff.--The Council, its members, and any committees of 
     the Council shall be provided with such secretarial, 
     clerical, or other assistance as may be authorized by the 
     Board for carrying out their respective functions.
       (h) Meetings.--The Council shall meet as frequently as the 
     Board deems necessary, but not less than 4 times each year. 
     Upon request by 7 or more members it shall be the duty of the 
     Chair to call a meeting of the Council.
       (i) Compensation.--Members of the Council shall be 
     reimbursed by the Board for travel and per diem in lieu of 
     subsistence expenses during the performance of duties of the 
     Board in accordance with subchapter I of chapter 57 of title 
     5, United States Code.
       (j) FACA Not Applicable.--The provisions of the Federal 
     Advisory Committee Act shall not apply to the Council.

     SEC. 1303. CONSULTATION WITH PRIVATE ENTITIES.

       The Secretary and the Board shall consult with private 
     entities, such as professional societies, national 
     associations, nationally recognized associations of experts, 
     medical schools and academic health centers, consumer groups, 
     and labor and business organizations in the formulation of 
     guidelines, regulations, policy initiatives, and information 
     gathering to assure the broadest and most informed input in 
     the administration of this title. Nothing in this title shall 
     prevent the Secretary from adopting guidelines developed by 
     such a private entity if, in the Secretary's and Board's 
     judgment, such guidelines are generally accepted as 
     reasonable and prudent and consistent with this title.

     SEC. 1304. STATE HEALTH SECURITY PROGRAMS.

       (a) Submission of Plans.--
       (1) In general.--Each State shall submit to the Board a 
     plan for a State health security program for providing for 
     health care services to the residents of the State in 
     accordance with this title.
       (2) Regional programs.--A State may join with 1 or more 
     neighboring States to submit to the Board a plan for a 
     regional health security program instead of separate State 
     health security programs.
       (3) Regional planning mechanisms.--The Board shall provide 
     incentives for States to develop regional planning mechanisms 
     to promote the rational distribution of, adequate access to, 
     and efficient use of, tertiary care facilities, equipment, 
     and services.
       (b) Review and Approval of Plans.--
       (1) In general.--The Board shall review plans submitted 
     under subsection (a) and determine whether such plans meet 
     the requirements for approval. The Board shall not approve 
     such a plan unless it finds that the plan (or State law) 
     provides, consistent with the provisions of this title, for 
     the following:
       (A) Payment for required health services for eligible 
     individuals in the State in accordance with this title.
       (B) Adequate administration, including the designation of a 
     single State agency responsible for the administration (or 
     supervision of the administration) of the program.
       (C) The establishment of a State health security budget.
       (D) Establishment of payment methodologies (consistent with 
     part II of subtitle E).
       (E) Assurances that individuals have the freedom to choose 
     practitioners and other health care providers for services 
     covered under this title.
       (F) A procedure for carrying out long-term regional 
     management and planning functions with respect to the 
     delivery and distribution of health care services that--
       (i) ensures participation of consumers of health services 
     and providers of health services; and
       (ii) gives priority to the most acute shortages and 
     maldistributions of health personnel and facilities and the 
     most serious deficiencies in the delivery of covered services 
     and to the means for the speedy alleviation of these 
     shortcomings.
       (G) The licensure and regulation of all health providers 
     and facilities to ensure compliance with Federal and State 
     laws and to promote quality of care.
       (H) Establishment of an independent ombudsman for consumers 
     to register complaints about the organization and 
     administration of the State health security program and to 
     help resolve complaints and disputes between consumers and 
     providers.
       (I) Publication of an annual report on the operation of the 
     State health security program, which report shall include 
     information on cost, progress towards achieving full 
     enrollment, public access to health services, quality review, 
     health outcomes, health professional training, and the needs 
     of medically underserved populations.
       (J) Provision of a fraud and abuse prevention and control 
     unit that the Inspector General determines meets the 
     requirements of section 1309(a).
       (K) Prohibit payment in cases of prohibited physician 
     referrals under section 1204.
       (2) Consequences of failure to comply.--If the Board finds 
     that a State plan submitted under paragraph (1) does not meet 
     the

[[Page S12181]]

     requirements for approval under this section or that a State 
     health security program or specific portion of such program, 
     the plan for which was previously approved, no longer meets 
     such requirements, the Board shall provide notice to the 
     State of such failure and that unless corrective action is 
     taken within a period specified by the Board, the Board shall 
     place the State health security program (or specific portions 
     of such program) in receivership under the jurisdiction of 
     the Board.
       (c) State Health Security Advisory Councils.--
       (1) In general.--For each State, the Governor shall provide 
     for appointment of a State Health Security Advisory Council 
     to advise and make recommendations to the Governor and State 
     with respect to the implementation of the State health 
     security program in the State.
       (2) Membership.--Each State Health Security Advisory 
     Council shall be composed of at least 11 individuals. The 
     appointed members shall include individuals who are 
     representative of the State health security program, public 
     health professionals, providers of health services, and of 
     individuals (who shall constitute a majority) who are 
     representative of consumers of such services, including a 
     balanced representation of employers, unions and consumer 
     organizations. To the greatest extent feasible, the 
     membership of each State Health Security Advisory Council 
     shall represent the various geographic regions of the State 
     and shall reflect the racial, ethnic, and gender composition 
     of the population of the State.
       (3) Duties.--
       (A) In general.--Each State Health Security Advisory 
     Council shall review, and submit comments to the Governor 
     concerning the implementation of the State health security 
     program in the State.
       (B) Assistance.--Each State Health Security Advisory 
     Council shall provide assistance and technical support to 
     community organizations and public and private non-profit 
     agencies submitting applications for funding under 
     appropriate State and Federal public health programs, with 
     particular emphasis placed on assisting those applicants with 
     broad consumer representation.
       (d) State Use of Fiscal Agents.--
       (1) In general.--Each State health security program, using 
     competitive bidding procedures, may enter into such contracts 
     with qualified entities, such as voluntary associations, as 
     the State determines to be appropriate to process claims and 
     to perform other related functions of fiscal agents under the 
     State health security program.
       (2) Restriction.--Except as the Board may provide for good 
     cause shown, in no case may more than 1 contract described in 
     paragraph (1) be entered into under a State health security 
     program.

     SEC. 1305. COMPLEMENTARY CONDUCT OF RELATED HEALTH PROGRAMS.

       In performing functions with respect to health personnel 
     education and training, health research, environmental 
     health, disability insurance, vocational rehabilitation, the 
     regulation of food and drugs, and all other matters 
     pertaining to health, the Secretary of Health and Human 
     Services shall direct all activities of the Department of 
     Health and Human Services toward contributions to the health 
     of the people complementary to this title.

                 PART II--CONTROL OVER FRAUD AND ABUSE

     SEC. 1310. APPLICATION OF FEDERAL SANCTIONS TO ALL FRAUD AND 
                   ABUSE UNDER AMERICAN HEALTH SECURITY PROGRAM.

       The following sections of the Social Security Act shall 
     apply to State health security programs in the same manner as 
     they apply to State medical assistance plans under title XIX 
     of such Act (except that in applying such provisions any 
     reference to the Secretary is deemed a reference to the 
     Board):
       (1) Section 1128 (relating to exclusion of individuals and 
     entities).
       (2) Section 1128A (civil monetary penalties).
       (3) Section 1128B (criminal penalties).
       (4) Section 1124 (relating to disclosure of ownership and 
     related information).
       (5) Section 1126 (relating to disclosure of certain 
     owners).

     SEC. 1311. REQUIREMENTS FOR OPERATION OF STATE HEALTH CARE 
                   FRAUD AND ABUSE CONTROL UNITS.

       (a) Requirement.--In order to meet the requirement of 
     section 1304(b)(1)(J), each State health security program 
     must establish and maintain a health care fraud and abuse 
     control unit (in this section referred to as a ``fraud 
     unit'') that meets requirements of this section and other 
     requirements of the Board. Such a unit may be a State 
     medicaid fraud control unit (described in section 1903(q) of 
     the Social Security Act).
       (b) Structure of Unit.--The fraud unit must--
       (1) be a single identifiable entity of the State 
     government;
       (2) be separate and distinct from the State agency with 
     principal responsibility for the administration of the State 
     health security program; and
       (3) meet 1 of the following requirements:
       (A) It must be a unit of the office of the State Attorney 
     General or of another department of State government which 
     possesses statewide authority to prosecute individuals for 
     criminal violations.
       (B) If it is in a State the constitution of which does not 
     provide for the criminal prosecution of individuals by a 
     statewide authority and has formal procedures, approved by 
     the Board, that--
       (i) assure its referral of suspected criminal violations 
     relating to the State health insurance plan to the 
     appropriate authority or authorities in the States for 
     prosecution; and
       (ii) assure its assistance of, and coordination with, such 
     authority or authorities in such prosecutions.
       (C) It must have a formal working relationship with the 
     office of the State Attorney General and have formal 
     procedures (including procedures for its referral of 
     suspected criminal violations to such office) which are 
     approved by the Board and which provide effective 
     coordination of activities between the fraud unit and such 
     office with respect to the detection, investigation, and 
     prosecution of suspected criminal violations relating to the 
     State health insurance plan.
       (c) Functions.--The fraud unit must--
       (1) have the function of conducting a statewide program for 
     the investigation and prosecution of violations of all 
     applicable State laws regarding any and all aspects of fraud 
     in connection with any aspect of the provision of health care 
     services and activities of providers of such services under 
     the State health security program;
       (2) have procedures for reviewing complaints of the abuse 
     and neglect of patients of providers and facilities that 
     receive payments under the State health security program, 
     and, where appropriate, for acting upon such complaints under 
     the criminal laws of the State or for referring them to other 
     State agencies for action; and
       (3) provide for the collection, or referral for collection 
     to a single State agency, of overpayments that are made under 
     the State health security program to providers and that are 
     discovered by the fraud unit in carrying out its activities.
       (d) Resources.--The fraud unit must--
       (1) employ such auditors, attorneys, investigators, and 
     other necessary personnel;
       (2) be organized in such a manner; and
       (3) provide sufficient resources (as specified by the 
     Board),

     as is necessary to promote the effective and efficient 
     conduct of the unit's activities.
       (e) Cooperative Agreements.--The fraud unit must have 
     cooperative agreements (as specified by the Board) with--
       (1) similar fraud units in other States;
       (2) the Inspector General; and
       (3) the Attorney General of the United States.
       (f) Reports.--The fraud unit must submit to the Inspector 
     General an application and annual reports containing such 
     information as the Inspector General determines to be 
     necessary to determine whether the unit meets the previous 
     requirements of this section.

                     Subtitle E--Quality Assessment

     SEC. 1401. AMERICAN HEALTH SECURITY QUALITY COUNCIL.

       (a) Establishment.--There is hereby established an American 
     Health Security Quality Council (in this subtitle referred to 
     as the ``Council'').
       (b) Duties of the Council.--The Council shall perform the 
     following duties:
       (1) Practice guidelines.--The Council shall review and 
     evaluate each practice guideline developed under part B of 
     title IX of the Public Health Service Act. The Council shall 
     determine whether the guideline should be recognized as a 
     national practice guideline to be used under section 1104(d) 
     for purposes of determining payments under a State health 
     security program.
       (2) Standards of quality, performance measures, and medical 
     review criteria.--The Council shall review and evaluate each 
     standard of quality, performance measure, and medical review 
     criterion developed under part B of title IX of the Public 
     Health Service Act. The Council shall determine whether the 
     standard, measure, or criterion is appropriate for use in 
     assessing or reviewing the quality of services provided by 
     State health security programs, health care institutions, or 
     health care professionals.
       (3) Criteria for entities conducting quality reviews.--The 
     Council shall develop minimum criteria for competence for 
     entities that can qualify to conduct ongoing and continuous 
     external quality review for State quality review programs 
     under section 1403. Such criteria shall require such an 
     entity to be administratively independent of the individual 
     or board that administers the State health security program 
     and shall ensure that such entities do not provide financial 
     incentives to reviewers to favor one pattern of practice over 
     another. The Council shall ensure coordination and reporting 
     by such entities to assure national consistency in quality 
     standards.
       (4) Reporting.--The Council shall report to the Board 
     annually on the conduct of activities under such title and 
     shall report to the Board annually specifically on findings 
     from outcomes research and development of practice guidelines 
     that may affect the Board's determination of coverage of 
     services under section 401(f)(1)(G).
       (5) Other functions.--The Council shall perform the 
     functions of the Council described in section 1402.
       (c) Appointment and Terms of Members.--
       (1) In general.--The Council shall be composed of 10 
     members appointed by the President. The President shall first 
     appoint individuals on a timely basis so as to provide for 
     the operation of the Council by not later than January 1, 
     2010.
       (2) Selection of members.--Each member of the Council shall 
     be a member of a health

[[Page S12182]]

     profession. Five members of the Council shall be physicians. 
     Individuals shall be appointed to the Council on the basis of 
     national reputations for clinical and academic excellence. To 
     the greatest extent feasible, the membership of the Council 
     shall represent the various geographic regions of the United 
     States and shall reflect the racial, ethnic, and gender 
     composition of the population of the United States.
       (3) Terms of members.--Individuals appointed to the Council 
     shall serve for a term of 5 years, except that the terms of 4 
     of the individuals initially appointed shall be, as 
     designated by the President at the time of their appointment, 
     for 1, 2, 3, and 4 years.
       (d) Vacancies.--
       (1) In general.--The President shall fill any vacancy in 
     the membership of the Council in the same manner as the 
     original appointment. The vacancy shall not affect the power 
     of the remaining members to execute the duties of the 
     Council.
       (2) Vacancy appointments.--Any member appointed to fill a 
     vacancy shall serve for the remainder of the term for which 
     the predecessor of the member was appointed.
       (3) Reappointment.--The President may reappoint a member of 
     the Council for a second term in the same manner as the 
     original appointment. A member who has served for 2 
     consecutive 5-year terms shall not be eligible for 
     reappointment until 2 years after the member has ceased to 
     serve.
       (e) Chair.--The President shall designate 1 of the members 
     of the Council to serve at the will of the President as Chair 
     of the Council.
       (f) Compensation.--Members of the Council who are not 
     employees of the Federal Government shall be entitled to 
     compensation at a level equivalent to level II of the 
     Executive Schedule, in accordance with section 5313 of title 
     5, United States Code.

     SEC. 1402. DEVELOPMENT OF CERTAIN METHODOLOGIES, GUIDELINES, 
                   AND STANDARDS.

       (a) Profiling of Patterns of Practice; Identification of 
     Outliers.--The Council shall adopt methodologies for 
     profiling the patterns of practice of health care 
     professionals and for identifying outliers (as defined in 
     subsection (e)).
       (b) Centers of Excellence.--The Council shall develop 
     guidelines for certain medical procedures designated by the 
     Board to be performed only at tertiary care centers which can 
     meet standards for frequency of procedure performance and 
     intensity of support mechanisms that are consistent with the 
     high probability of desired patient outcome. Reimbursement 
     under this Act for such a designated procedure may only be 
     provided if the procedure was performed at a center that 
     meets such standards.
       (c) Remedial Actions.--The Council shall develop standards 
     for education and sanctions with respect to outliers so as to 
     assure the quality of health care services provided under 
     this Act. The Council shall develop criteria for referral of 
     providers to the State licensing board if education proves 
     ineffective in correcting provider practice behavior.
       (d) Dissemination.--The Council shall disseminate to the 
     State--
       (1) the methodologies adopted under subsection (a);
       (2) the guidelines developed under subsection (b); and
       (3) the standards developed under subsection (c);

     for use by the States under section 1403.
       (e) Outlier Defined.--In this title, the term ``outlier'' 
     means a health care provider whose pattern of practice, 
     relative to applicable practice guidelines, suggests 
     deficiencies in the quality of health care services being 
     provided.

     SEC. 1403. STATE QUALITY REVIEW PROGRAMS.

       (a) Requirement.--In order to meet the requirement of 
     section 404(b)(1)(H), each State health security program 
     shall establish 1 or more qualified entities to conduct 
     quality reviews of persons providing covered services under 
     the program, in accordance with standards established under 
     subsection (b)(1) (except as provided in subsection (b)(2)) 
     and subsection (d).
       (b) Federal Standards.--
       (1) In general.--The Council shall establish standards with 
     respect to--
       (A) the adoption of practice guidelines (whether developed 
     by the Federal Government or other entities);
       (B) the identification of outliers (consistent with 
     methodologies adopted under section 1402(a));
       (C) the development of remedial programs and monitoring for 
     outliers; and
       (D) the application of sanctions (consistent with the 
     standards developed under section 1402(c)).
       (2) State discretion.--A State may apply under subsection 
     (a) standards other than those established under paragraph 
     (1) so long as the State demonstrates to the satisfaction of 
     the Council on an annual basis that the standards applied 
     have been as efficacious in promoting and achieving improved 
     quality of care as the application of the standards 
     established under paragraph (1). Positive improvements in 
     quality shall be documented by reductions in the variations 
     of clinical care process and improvement in patient outcomes.
       (c) Qualifications.--An entity is not qualified to conduct 
     quality reviews under subsection (a) unless the entity 
     satisfies the criteria for competence for such entities 
     developed by the Council under section 1401(b)(3).
       (d) Internal Quality Review.--Nothing in this section shall 
     preclude an institutional provider from establishing its own 
     internal quality review and enhancement programs.

     SEC. 1404. ELIMINATION OF UTILIZATION REVIEW PROGRAMS; 
                   TRANSITION.

       (a) Intent.--It is the intention of this title to replace 
     by January 1, 2013, random utilization controls with a 
     systematic review of patterns of practice that compromise the 
     quality of care.
       (b) Superseding Case Reviews.--
       (1) In general.--Subject to the succeeding provisions of 
     this subsection, the program of quality review provided under 
     the previous sections of this title supersede all existing 
     Federal requirements for utilization review programs, 
     including requirements for random case-by-case reviews and 
     programs requiring pre-certification of medical procedures on 
     a case-by-case basis.
       (2) Transition.--Before January 1, 2013, the Board and the 
     States may employ existing utilization review standards and 
     mechanisms as may be necessary to effect the transition to 
     pattern of practice-based reviews.
       (3) Construction.--Nothing in this subsection shall be 
     construed--
       (A) as precluding the case-by-case review of the provision 
     of care--
       (i) in individual incidents where the quality of care has 
     significantly deviated from acceptable standards of practice; 
     and
       (ii) with respect to a provider who has been determined to 
     be an outlier; or
       (B) as precluding the case management of catastrophic, 
     mental health, or substance abuse cases or long-term care 
     where such management is necessary to achieve appropriate, 
     cost-effective, and beneficial comprehensive medical care, as 
     provided for in section 1104.

Subtitle F--Health Security Budget; Payments; Cost Containment Measures

                PART I--BUDGETING AND PAYMENTS TO STATES

     SEC. 1501. NATIONAL HEALTH SECURITY BUDGET.

       (a) National Health Security Budget.--
       (1) In general.--By not later than September 1 before the 
     beginning of each year (beginning with 2010), the Board shall 
     establish a national health security budget, which--
       (A) specifies the total expenditures (including 
     expenditures for administrative costs) to be made by the 
     Federal Government and the States for covered health care 
     services under this title; and
       (B) allocates those expenditures among the States 
     consistent with section 1504.

     Pursuant to subsection (b), such budget for a year shall not 
     exceed the budget for the preceding year increased by the 
     percentage increase in gross domestic product.
       (2) Division of budget into components.--The national 
     health security budget shall consist of at least 4 
     components:
       (A) A component for quality assessment activities 
     (described in subtitle E).
       (B) A component for health professional education 
     expenditures.
       (C) A component for administrative costs.
       (D) A component (in this subtitle referred to as the 
     ``operating component'') for operating and other expenditures 
     not described in subparagraphs (A) through (C), consisting of 
     amounts not included in the other components. A State may 
     provide for the allocation of this component between capital 
     expenditures and other expenditures.
       (3) Allocation among components.--Taking into account the 
     State health security budgets established and submitted under 
     section 1503, the Board shall allocate the national health 
     security budget among the components in a manner that--
       (A) assures a fair allocation for quality assessment 
     activities (consistent with the national health security 
     spending growth limit); and
       (B) assures that the health professional education 
     expenditure component is sufficient to provide for the amount 
     of health professional education expenditures sufficient to 
     meet the need for covered health care services (consistent 
     with the national health security spending growth limit under 
     subsection (b)(2)).
       (b) Basis for Total Expenditures.--
       (1) In general.--The total expenditures specified in such 
     budget shall be the sum of the capitation amounts computed 
     under section 1502(a) and the amount of Federal 
     administrative expenditures needed to carry out this title.
       (2) National health security spending growth limit.--For 
     purposes of this part, the national health security spending 
     growth limit described in this paragraph for a year is (A) 
     zero, or, if greater, (B) the average annual percentage 
     increase in the gross domestic product (in current dollars) 
     during the 3-year period beginning with the first quarter of 
     the fourth previous year to the first quarter of the previous 
     year minus the percentage increase (if any) in the number of 
     eligible individuals residing in any State the United States 
     from the first quarter of the second previous year to the 
     first quarter of the previous year.
       (c) Definitions.--In this title:
       (1) Capital expenditures.--The term ``capital 
     expenditures'' means expenses for the purchase, lease, 
     construction, or renovation of capital facilities and for 
     equipment and includes return on equity capital.
       (2) Health professional education expenditures.--The term 
     ``health professional

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     education expenditures'' means expenditures in hospitals and 
     other health care facilities to cover costs associated with 
     teaching and related research activities.

     SEC. 1502. COMPUTATION OF INDIVIDUAL AND STATE CAPITATION 
                   AMOUNTS.

       (a) Capitation Amounts.--
       (1) Individual capitation amounts.--In establishing the 
     national health security budget under section 1501(a) and in 
     computing the national average per capita cost under 
     subsection (b) for each year, the Board shall establish a 
     method for computing the capitation amount for each eligible 
     individual residing in each State. The capitation amount for 
     an eligible individual in a State classified within a risk 
     group (established under subsection (d)(2)) is the product 
     of--
       (A) a national average per capita cost for all covered 
     health care services (computed under subsection (b));
       (B) the State adjustment factor (established under 
     subsection (c)) for the State; and
       (C) the risk adjustment factor (established under 
     subsection (d)) for the risk group.
       (2) State capitation amount.--
       (A) In general.--For purposes of this title, the term 
     ``State capitation amount'' means, for a State for a year, 
     the sum of the capitation amounts computed under paragraph 
     (1) for all the residents of the State in the year, as 
     estimated by the Board before the beginning of the year 
     involved.
       (B) Use of statistical model.--The Board may provide for 
     the computation of State capitation amounts based on 
     statistical models that fairly reflect the elements that 
     comprise the State capitation amount described in 
     subparagraph (A).
       (C) Population information.--The Bureau of the Census shall 
     assist the Board in determining the number, place of 
     residence, and risk group classification of eligible 
     individuals.
       (b) Computation of National Average Per Capita Cost.--
       (1) For 2010.--For 2010, the national average per capita 
     cost under this paragraph is equal to--
       (A) the average per capita health care expenditures in the 
     United States in 2008 (as estimated by the Board);
       (B) increased to 2009 by the Board's estimate of the actual 
     amount of such per capita expenditures during 2009; and
       (C) updated to 2010 by the national health security 
     spending growth limit specified in section 1501(b)(2) for 
     2010.
       (2) For succeeding years.--For each succeeding year, the 
     national average per capita cost under this subsection is 
     equal to the national average per capita cost computed under 
     this subsection for the previous year increased by the 
     national health security spending growth limit (specified in 
     section 1501(b)(2)) for the year involved.
       (c) State Adjustment Factors.--
       (1) In general.--Subject to the succeeding paragraphs of 
     this subsection, the Board shall develop for each State a 
     factor to adjust the national average per capita costs to 
     reflect differences between the State and the United States 
     in--
       (A) average labor and nonlabor costs that are necessary to 
     provide covered health services;
       (B) any social, environmental, or geographic condition 
     affecting health status or the need for health care services, 
     to the extent such a condition is not taken into account in 
     the establishment of risk groups under subsection (d);
       (C) the geographic distribution of the State's population, 
     particularly the proportion of the population residing in 
     medically underserved areas, to the extent such a condition 
     is not taken into account in the establishment of risk groups 
     under subsection (d); and
       (D) any other factor relating to operating costs required 
     to assure equitable distribution of funds among the States.
       (2) Modification of health professional education 
     component.--With respect to the portion of the national 
     health security budget allocated to expenditures for health 
     professional education, the Board shall modify the State 
     adjustment factors so as to take into account--
       (A) differences among States in health professional 
     education programs in operation as of the date of the 
     enactment of this title; and
       (B) differences among States in their relative need for 
     expenditures for health professional education, taking into 
     account the health professional education expenditures 
     proposed in State health security budgets under section 
     1503(a).
       (3) Budget neutrality.--The State adjustment factors, as 
     modified under paragraph (2), shall be applied under this 
     subsection in a manner that results in neither an increase 
     nor a decrease in the total amount of the Federal 
     contributions to all State health security programs under 
     subsection (b) as a result of the application of such 
     factors.
       (4) Phase-in.--In applying State adjustment factors under 
     this subsection during the 5-year period beginning with 2010, 
     the Board shall phase-in, over such period, the use of 
     factors described in paragraph (1) in a manner so that the 
     adjustment factor for a State is based on a blend of such 
     factors and a factor that reflects the relative actual 
     average per capita costs of health services of the different 
     States as of the time of enactment of this title.
       (5) Periodic adjustment.--In establishing the national 
     health security budget before the beginning of each year, the 
     Board shall provide for appropriate adjustments in the State 
     adjustment factors under this subsection.
       (d) Adjustments for Risk Group Classification.--
       (1) In general.--The Board shall develop an adjustment 
     factor to the national average per capita costs computed 
     under subsection (b) for individuals classified in each risk 
     group (as designated under paragraph (2)) to reflect the 
     difference between the average national average per capita 
     costs and the national average per capita cost for 
     individuals classified in the risk group.
       (2) Risk groups.--The Board shall designate a series of 
     risk groups, determined by age, health indicators, and other 
     factors that represent distinct patterns of health care 
     services utilization and costs.
       (3) Periodic adjustment.--In establishing the national 
     health security budget before the beginning of each year, the 
     Board shall provide for appropriate adjustments in the risk 
     adjustment factors under this subsection.

     SEC. 1503. STATE HEALTH SECURITY BUDGETS.

       (a) Establishment and Submission of Budgets.--
       (1) In general.--Each State health security program shall 
     establish and submit to the Board for each year a proposed 
     and a final State health security budget, which specifies the 
     following:
       (A) The total expenditures (including expenditures for 
     administrative costs) to be made under the program in the 
     State for covered health care services under this title, 
     consistent with subsection (b), broken down as follows:
       (i) By the 4 components (described in section 1501(a)(2)), 
     consistent with subsection (b).
       (ii) Within the operating component--

       (I) expenditures for operating costs of hospitals and other 
     facility-based services in the State;
       (II) expenditures for payment to comprehensive health 
     service organizations;
       (III) expenditures for payment of services provided by 
     health care practitioners; and
       (IV) expenditures for other covered items and services.

     Amounts included in the operating component include amounts 
     that may be used by providers for capital expenditures.
       (B) The total revenues required to meet the State health 
     security expenditures.
       (2) Proposed budget deadline.--The proposed budget for a 
     year shall be submitted under paragraph (1) not later than 
     June 1 before the year.
       (3) Final budget.--The final budget for a year shall--
       (A) be established and submitted under paragraph (1) not 
     later than October 1 before the year, and
       (B) take into account the amounts established under the 
     national health security budget under section 1501 for the 
     year.
       (4) Adjustment in allocations permitted.--
       (A) In general.--Subject to subparagraphs (B) and (C), in 
     the case of a final budget, a State may change the allocation 
     of amounts among components.
       (B) Notice.--No such change may be made unless the State 
     has provided prior notice of the change to the Board.
       (C) Denial.--Such a change may not be made if the Board, 
     within such time period as the Board specifies, disapproves 
     such change.
       (b) Expenditure Limits.--
       (1) In general.--The total expenditures specified in each 
     State health security budget under subsection (a)(1) shall 
     take into account Federal contributions made under section 
     1504.
       (2) Limit on claims processing and billing expenditures.--
     Each State health security budget shall provide that State 
     administrative expenditures, including expenditures for 
     claims processing and billing, shall not exceed 3 percent of 
     the total expenditures under the State health security 
     program, unless the Board determines, on a case-by-case 
     basis, that additional administrative expenditures would 
     improve health care quality and cost effectiveness.
       (3) Worker assistance.--A State health security program may 
     provide that, for budgets for years before 2013, up to 1 
     percent of the budget may be used for purposes of programs 
     providing assistance to workers who are currently performing 
     functions in the administration of the health insurance 
     system and who may experience economic dislocation as a 
     result of the implementation of the program.
       (c) Approval Process for Capital Expenditures Permitted.--
     Nothing in this subtitle shall be construed as preventing a 
     State health security program from providing for a process 
     for the approval of capital expenditures based on information 
     derived from regional planning agencies.

     SEC. 1504. FEDERAL PAYMENTS TO STATES.

       (a) In General.--Each State with an approved State health 
     security program is entitled to receive, from amounts in the 
     American Health Security Trust Fund, on a monthly basis each 
     year, of an amount equal to one-twelfth of the product of--
       (1) the State capitation amount (computed under section 
     1502(a)(2)) for the State for the year; and
       (2) the Federal contribution percentage (established under 
     subsection (b)).
       (b) Federal Contribution Percentage.--The Board shall 
     establish a formula for the

[[Page S12184]]

     establishment of a Federal contribution percentage for each 
     State. Such formula shall take into consideration a State's 
     per capita income and revenue capacity and such other 
     relevant economic indicators as the Board determines to be 
     appropriate. In addition, during the 5-year period beginning 
     with 2010, the Board may provide for a transition adjustment 
     to the formula in order to take into account current 
     expenditures by the State (and local governments thereof) for 
     health services covered under the State health security 
     program. The weighted-average Federal contribution percentage 
     for all States shall equal 86 percent and in no event shall 
     such percentage be less than 81 percent nor more than 91 
     percent.
       (c) Use of Payments.--All payments made under this section 
     may only be used to carry out the State health security 
     program.
       (d) Effect of Spending Excess or Surplus.--
       (1) Spending excess.--If a State exceeds it's budget in a 
     given year, the State shall continue to fund covered health 
     services from its own revenues.
       (2) Surplus.--If a State provides all covered health 
     services for less than the budgeted amount for a year, it may 
     retain its Federal payment for that year for uses consistent 
     with this title.

     SEC. 1505. ACCOUNT FOR HEALTH PROFESSIONAL EDUCATION 
                   EXPENDITURES.

       (a) Separate Account.--Each State health security program 
     shall--
       (1) include a separate account for health professional 
     education expenditures; and
       (2) specify the general manner, consistent with subsection 
     (b), in which such expenditures are to be distributed among 
     different types of institutions and the different areas of 
     the State.
       (b) Distribution Rules.--The distribution of funds from the 
     account must take into account the potentially higher costs 
     of placing health professional students in clinical education 
     programs in health professional shortage areas.

                PART II--PAYMENTS BY STATES TO PROVIDERS

     SEC. 1510. PAYMENTS TO HOSPITALS AND OTHER FACILITY-BASED 
                   SERVICES FOR OPERATING EXPENSES ON THE BASIS OF 
                   APPROVED GLOBAL BUDGETS.

       (a) Direct Payment Under Global Budget.--Payment for 
     operating expenses for institutional and facility-based care, 
     including hospital services and nursing facility services, 
     under State health security programs shall be made directly 
     to each institution or facility by each State health security 
     program under an annual prospective global budget approved 
     under the program. Such a budget shall include payment for 
     outpatient care and non-facility-based care that is furnished 
     by or through the facility. In the case of a hospital that is 
     wholly owned (or controlled) by a comprehensive health 
     service organization that is paid under section 1513 on the 
     basis of a global budget, the global budget of the 
     organization shall include the budget for the hospital.
       (b) Annual Negotiations; Budget Approval.--
       (1) In general.--The prospective global budget for an 
     institution or facility shall--
       (A) be developed through annual negotiations between--
       (i) a panel of individuals who are appointed by the 
     Governor of the State and who represent consumers, labor, 
     business, and the State government; and
       (ii) the institution or facility; and
       (B) be based on a nationally uniform system of cost 
     accounting established under standards of the Board.
       (2) Considerations.--In developing a budget through 
     negotiations, there shall be taken into account at least the 
     following:
       (A) With respect to inpatient hospital services, the 
     number, and classification by diagnosis-related group, of 
     discharges.
       (B) An institution's or facility's past expenditures.
       (C) The extent to which debt service for capital 
     expenditures has been included in the proposed operating 
     budget.
       (D) The extent to which capital expenditures are financed 
     directly or indirectly through reductions in direct care to 
     patients, including (but not limited to) reductions in 
     registered nursing staffing patterns or changes in emergency 
     room or primary care services or availability.
       (E) Change in the consumer price index and other price 
     indices.
       (F) The cost of reasonable compensation to health care 
     practitioners.
       (G) The compensation level of the institution's or 
     facility's work force.
       (H) The extent to which the institution or facility is 
     providing health care services to meet the needs of residents 
     in the area served by the institution or facility, including 
     the institution's or facility's occupancy level.
       (I) The institution's or facility's previous financial and 
     clinical performance, based on utilization and outcomes data 
     provided under this title.
       (J) The type of institution or facility, including whether 
     the institution or facility is part of a clinical education 
     program or serves a health professional education, research 
     or other training purpose.
       (K) Technological advances or changes.
       (L) Costs of the institution or facility associated with 
     meeting Federal and State regulations.
       (M) The costs associated with necessary public outreach 
     activities.
       (N) In the case of a for-profit facility, a reasonable rate 
     of return on equity capital, independent of those operating 
     expenses necessary to fulfill the objectives of this title.
       (O) Incentives to facilities that maintain costs below 
     previous reasonable budgeted levels without reducing the care 
     provided.
       (P) With respect to facilities that provide mental health 
     services and substance abuse treatment services, any 
     additional costs involved in the treatment of dually 
     diagnosed individuals.

     The portion of such a budget that relates to expenditures for 
     health professional education shall be consistent with the 
     State health security budget for such expenditures.
       (3) Provision of required information; diagnosis-related 
     group.--No budget for an institution or facility for a year 
     may be approved unless the institution or facility has 
     submitted on a timely basis to the State health security 
     program such information as the program or the Board shall 
     specify, including in the case of hospitals information on 
     discharges classified by diagnosis-related group.
       (c) Adjustments in Approved Budgets.--
       (1) Adjustments to global budgets that contract with 
     comprehensive health service organizations.--Each State 
     health security program shall develop an administrative 
     mechanism for reducing operating funds to institutions or 
     facilities in proportion to payments made to such 
     institutions or facilities for services contracted for by a 
     comprehensive health service organization.
       (2) Amendments.--In accordance with standards established 
     by the Board, an operating and capital budget approved under 
     this section for a year may be amended before, during, or 
     after the year if there is a substantial change in any of the 
     factors relevant to budget approval.
       (d) Donations Permissible.--The States health security 
     programs may permit institutions and facilities to raise 
     funds from private sources to pay for newly constructed 
     facilities, major renovations, and equipment. The expenditure 
     of such funds, whether for operating or capital expenditures, 
     does not obligate the State health security program to 
     provide for continued support for such expenditures unless 
     included in an approved global budget.

     SEC. 1511. PAYMENTS TO HEALTH CARE PRACTITIONERS BASED ON 
                   PROSPECTIVE FEE SCHEDULE.

       (a) Fee for Service.--
       (1) In general.--Every independent health care practitioner 
     is entitled to be paid, for the provision of covered health 
     services under the State health security program, a fee for 
     each billable covered service.
       (2) Global fee payment methodologies.--The Board shall 
     establish models and encourage State health security programs 
     to implement alternative payment methodologies that 
     incorporate global fees for related services (such as all 
     outpatient procedures for treatment of a condition) or for a 
     basic group of services (such as primary care services) 
     furnished to an individual over a period of time, in order to 
     encourage continuity and efficiency in the provision of 
     services. Such methodologies shall be designed to ensure a 
     high quality of care.
       (3) Billing deadlines; electronic billing.--A State health 
     security program may deny payment for any service of an 
     independent health care practitioner for which it did not 
     receive a bill and appropriate supporting documentation 
     (which had been previously specified) within 30 days after 
     the date the service was provided. Such a program may require 
     that bills for services for which payment may be made under 
     this section, or for any class of such services, be submitted 
     electronically.
       (b) Payment Rates Based on Negotiated Prospective Fee 
     Schedules.--With respect to any payment method for a class of 
     services of practitioners, the State health security program 
     shall establish, on a prospective basis, a payment schedule. 
     The State health security program may establish such a 
     schedule after negotiations with organizations representing 
     the practitioners involved. Such fee schedules shall be 
     designed to provide incentives for practitioners to choose 
     primary care medicine, including general internal medicine 
     and pediatrics, over medical specialization. Nothing in this 
     section shall be construed as preventing a State from 
     adjusting the payment schedule amounts on a quarterly or 
     other periodic basis depending on whether expenditures under 
     the schedule will exceed the budgeted amount with respect to 
     such expenditures.
       (c) Billable Covered Service Defined.--In this section, the 
     term ``billable covered service'' means a service covered 
     under section 1101 for which a practitioner is entitled to 
     compensation by payment of a fee determined under this 
     section.

     SEC. 1512. PAYMENTS TO COMPREHENSIVE HEALTH SERVICE 
                   ORGANIZATIONS.

       (a) In General.--Payment under a State health security 
     program to a comprehensive health service organization to its 
     enrollees shall be determined by the State--
       (1) based on a global budget described in section 1510; or
       (2) based on the basic capitation amount described in 
     subsection (b) for each of its enrollees.
       (b) Basic Capitation Amount.--
       (1) In general.--The basic capitation amount described in 
     this subsection for an enrollee shall be determined by the 
     State health security program on the basis of the average 
     amount of expenditures that is estimated would be made under 
     the State health security program for covered health care 
     services for an enrollee, based on actuarial

[[Page S12185]]

     characteristics (as defined by the State health security 
     program).
       (2) Adjustment for special health needs.--The State health 
     security program shall adjust such average amounts to take 
     into account the special health needs, including a 
     disproportionate number of medically underserved individuals, 
     of populations served by the organization.
       (3) Adjustment for services not provided.--The State health 
     security program shall adjust such average amounts to take 
     into account the cost of covered health care services that 
     are not provided by the comprehensive health service 
     organization under section 1203(a).

     SEC. 1513. PAYMENTS FOR COMMUNITY-BASED PRIMARY HEALTH 
                   SERVICES.

       (a) In General.--In the case of community-based primary 
     health services, subject to subsection (b), payments under a 
     State health security program shall--
       (1) be based on a global budget described in section 1510;
       (2) be based on the basic primary care capitation amount 
     described in subsection (c) for each individual enrolled with 
     the provider of such services; or
       (3) be made on a fee-for-service basis under section 1511.
       (b) Payment Adjustment.--Payments under subsection (a) may 
     include, consistent with the budgets developed under this 
     title--
       (1) an additional amount, as set by the State health 
     security program, to cover the costs incurred by a provider 
     which serves persons not covered by this title whose health 
     care is essential to overall community health and the control 
     of communicable disease, and for whom the cost of such care 
     is otherwise uncompensated;
       (2) an additional amount, as set by the State health 
     security program, to cover the reasonable costs incurred by a 
     provider that furnishes case management services (as defined 
     in section 1915(g)(2) of the Social Security Act), 
     transportation services, and translation services; and
       (3) an additional amount, as set by the State health 
     security program, to cover the costs incurred by a provider 
     in conducting health professional education programs in 
     connection with the provision of such services.
       (c) Basic Primary Care Capitation Amount.--
       (1) In general.--The basic primary care capitation amount 
     described in this subsection for an enrollee with a provider 
     of community-based primary health services shall be 
     determined by the State health security program on the basis 
     of the average amount of expenditures that is estimated would 
     be made under the State health security program for such an 
     enrollee, based on actuarial characteristics (as defined by 
     the State health security program).
       (2) Adjustment for special health needs.--The State health 
     security program shall adjust such average amounts to take 
     into account the special health needs, including a 
     disproportionate number of medically underserved individuals, 
     of populations served by the provider.
       (3) Adjustment for services not provided.--The State health 
     security program shall adjust such average amounts to take 
     into account the cost of community-based primary health 
     services that are not provided by the provider.
       (d) Community-Based Primary Health Services Defined.--In 
     this section, the term ``community-based primary health 
     services'' has the meaning given such term in section 
     1102(a).

     SEC. 1514. PAYMENTS FOR PRESCRIPTION DRUGS.

       (a) Establishment of List.--
       (1) In general.--The Board shall establish a list of 
     approved prescription drugs and biologicals that the Board 
     determines are necessary for the maintenance or restoration 
     of health or of employability or self-management and eligible 
     for coverage under this title.
       (2) Exclusions.--The Board may exclude reimbursement under 
     this title for ineffective, unsafe, or over-priced products 
     where better alternatives are determined to be available.
       (b) Prices.--For each such listed prescription drug or 
     biological covered under this title, for insulin, and for 
     medical foods, the Board shall from time to time determine a 
     product price or prices which shall constitute the maximum to 
     be recognized under this title as the cost of a drug to a 
     provider thereof. The Board may conduct negotiations, on 
     behalf of State health security programs, with product 
     manufacturers and distributors in determining the applicable 
     product price or prices.
       (c) Charges by Independent Pharmacies.--Each State health 
     security program shall provide for payment for a prescription 
     drug or biological or insulin furnished by an independent 
     pharmacy based on the drug's cost to the pharmacy (not in 
     excess of the applicable product price established under 
     subsection (b)) plus a dispensing fee. In accordance with 
     standards established by the Board, each State health 
     security program, after consultation with representatives of 
     the pharmaceutical profession, shall establish schedules of 
     dispensing fees, designed to afford reasonable compensation 
     to independent pharmacies after taking into account 
     variations in their cost of operation resulting from regional 
     differences, differences in the volume of prescription drugs 
     dispensed, differences in services provided, the need to 
     maintain expenditures within the budgets established under 
     this title, and other relevant factors.

     SEC. 1515. PAYMENTS FOR APPROVED DEVICES AND EQUIPMENT.

       (a) Establishment of List.--The Board shall establish a 
     list of approved durable medical equipment and therapeutic 
     devices and equipment (including eyeglasses, hearing aids, 
     and prosthetic appliances), that the Board determines are 
     necessary for the maintenance or restoration of health or of 
     employability or self-management and eligible for coverage 
     under this title.
       (b) Considerations and Conditions.--In establishing the 
     list under subsection (a), the Board shall take into 
     consideration the efficacy, safety, and cost of each item 
     contained on such list, and shall attach to any item such 
     conditions as the Board determines appropriate with respect 
     to the circumstances under which, or the frequency with 
     which, the item may be prescribed.
       (c) Prices.--For each such listed item covered under this 
     title, the Board shall from time to time determine a product 
     price or prices which shall constitute the maximum to be 
     recognized under this title as the cost of the item to a 
     provider thereof. The Board may conduct negotiations, on 
     behalf of State health security programs, with equipment and 
     device manufacturers and distributors in determining the 
     applicable product price or prices.
       (d) Exclusions.--The Board may exclude from coverage under 
     this title ineffective, unsafe, or overpriced products where 
     better alternatives are determined to be available.

     SEC. 1516. PAYMENTS FOR OTHER ITEMS AND SERVICES.

       In the case of payment for other covered health services, 
     the amount of payment under a State health security program 
     shall be established by the program--
       (1) in accordance with payment methodologies which are 
     specified by the Board, after consultation with the American 
     Health Security Advisory Council, or methodologies 
     established by the State under section 1519; and
       (2) consistent with the State health security budget.

     SEC. 1517. PAYMENT INCENTIVES FOR MEDICALLY UNDERSERVED 
                   AREAS.

       (a) Model Payment Methodologies.--In addition to the 
     payment amounts otherwise provided in this title, the Board 
     shall establish model payment methodologies and other 
     incentives that promote the provision of covered health care 
     services in medically underserved areas, particularly in 
     rural and inner-city underserved areas.
       (b) Construction.--Nothing in this subtitle shall be 
     construed as limiting the authority of State health security 
     programs to increase payment amounts or otherwise provide 
     additional incentives, consistent with the State health 
     security budget, to encourage the provision of medically 
     necessary and appropriate services in underserved areas.

     SEC. 1518. AUTHORITY FOR ALTERNATIVE PAYMENT METHODOLOGIES.

       A State health security program, as part of its plan under 
     section 1304(a), may use a payment methodology other than a 
     methodology required under this part so long as--
       (1) such payment methodology does not affect the 
     entitlement of individuals to coverage, the weighting of fee 
     schedules to encourage an increase in the number of primary 
     care providers, the ability of individuals to choose among 
     qualified providers, the benefits covered under the program, 
     or the compliance of the program with the State health 
     security budget under part I; and
       (2) the program submits periodic reports to the Board 
     showing the operation and effectiveness of the alternative 
     methodology, in order for the Board to evaluate the 
     appropriateness of applying the alternative methodology to 
     other States.

      PART III--MANDATORY ASSIGNMENT AND ADMINISTRATIVE PROVISIONS

     SEC. 1520. MANDATORY ASSIGNMENT.

       (a) No Balance Billing.--Payments for benefits under this 
     title shall constitute payment in full for such benefits and 
     the entity furnishing an item or service for which payment is 
     made under this title shall accept such payment as payment in 
     full for the item or service and may not accept any payment 
     or impose any charge for any such item or service other than 
     accepting payment from the State health security program in 
     accordance with this title.
       (b) Enforcement.--If an entity knowingly and willfully 
     bills for an item or service or accepts payment in violation 
     of subsection (a), the Board may apply sanctions against the 
     entity in the same manner as sanctions could have been 
     imposed under section 1842(j)(2) of the Social Security Act 
     for a violation of section 1842(j)(1) of such Act. Such 
     sanctions are in addition to any sanctions that a State may 
     impose under its State health security program.

     SEC. 1521. PROCEDURES FOR REIMBURSEMENT; APPEALS.

       (a) Procedures for Reimbursement.--In accordance with 
     standards issued by the Board, a State health security 
     program shall establish a timely and administratively simple 
     procedure to assure payment within 60 days of the date of 
     submission of clean claims by providers under this title.
       (b) Appeals Process.--Each State health security program 
     shall establish an appeals process to handle all grievances 
     pertaining to payment to providers under this title.

[[Page S12186]]

 Subtitle G--Financing Provisions; American Health Security Trust Fund

     SEC. 1530. AMENDMENT OF 1986 CODE; SECTION 15 NOT TO APPLY.

       (a) Amendment of 1986 Code.--Except as otherwise expressly 
     provided, whenever in this subtitle an amendment or repeal is 
     expressed in terms of an amendment to, or repeal of, a 
     section or other provision, the reference shall be considered 
     to be made to a section or other provision of the Internal 
     Revenue Code of 1986.
       (b) Section 15 Not To Apply.--The amendments made by part 
     II shall not be treated as a change in a rate of tax for 
     purposes of section 15 of the Internal Revenue Code of 1986.

              PART I--AMERICAN HEALTH SECURITY TRUST FUND

     SEC. 1531. AMERICAN HEALTH SECURITY TRUST FUND.

       (a) In General.--There is hereby created on the books of 
     the Treasury of the United States a trust fund to be known as 
     the American Health Security Trust Fund (in this section 
     referred to as the ``Trust Fund''). The Trust Fund shall 
     consist of such gifts and bequests as may be made and such 
     amounts as may be deposited in, or appropriated to, such 
     Trust Fund as provided in this title.
       (b) Appropriations Into Trust Fund.--
       (1) Taxes.--There are hereby appropriated to the Trust Fund 
     for each fiscal year (beginning with fiscal year 2011), out 
     of any moneys in the Treasury not otherwise appropriated, 
     amounts equivalent to 100 percent of the aggregate increase 
     in tax liabilities under the Internal Revenue Code of 1986 
     which is attributable to the application of the amendments 
     made by this subtitle. The amounts appropriated by the 
     preceding sentence shall be transferred from time to time 
     (but not less frequently than monthly) from the general fund 
     in the Treasury to the Trust Fund, such amounts to be 
     determined on the basis of estimates by the Secretary of the 
     Treasury of the taxes paid to or deposited into the Treasury; 
     and proper adjustments shall be made in amounts subsequently 
     transferred to the extent prior estimates were in excess of 
     or were less than the amounts that should have been so 
     transferred.
       (2) Current program receipts.--Notwithstanding any other 
     provision of law, there are hereby appropriated to the Trust 
     Fund for each fiscal year (beginning with fiscal year 2011) 
     the amounts that would otherwise have been appropriated to 
     carry out the following programs:
       (A) The medicare program, under parts A, B, and D of title 
     XVIII of the Social Security Act (other than amounts 
     attributable to any premiums under such parts).
       (B) The medicaid program, under State plans approved under 
     title XIX of such Act.
       (C) The Federal employees health benefit program, under 
     chapter 89 of title 5, United States Code.
       (D) The TRICARE program (formerly known as the CHAMPUS 
     program), under chapter 55 of title 10, United States Code.
       (E) The maternal and child health program (under title V of 
     the Social Security Act), vocational rehabilitation programs, 
     programs for drug abuse and mental health services under the 
     Public Health Service Act, programs providing general 
     hospital or medical assistance, and any other Federal program 
     identified by the Board, in consultation with the Secretary 
     of the Treasury, to the extent the programs provide for 
     payment for health services the payment of which may be made 
     under this title.
       (c) Incorporation of Provisions.--The provisions of 
     subsections (b) through (i) of section 1817 of the Social 
     Security Act shall apply to the Trust Fund under this title 
     in the same manner as they applied to the Federal Hospital 
     Insurance Trust Fund under part A of title XVIII of such Act, 
     except that the American Health Security Standards Board 
     shall constitute the Board of Trustees of the Trust Fund.
       (d) Transfer of Funds.--Any amounts remaining in the 
     Federal Hospital Insurance Trust Fund or the Federal 
     Supplementary Medical Insurance Trust Fund after the 
     settlement of claims for payments under title XVIII have been 
     completed, shall be transferred into the American Health 
     Security Trust Fund.

                PART II--TAXES BASED ON INCOME AND WAGES

     SEC. 1535. PAYROLL TAX ON EMPLOYERS.

       (a) In General.--Section 3111 (relating to tax on 
     employers) is amended by redesignating subsection (c) as 
     subsection (d) and inserting after subsection (b) the 
     following new subsection:
       ``(c) Health Care.--In addition to other taxes, there is 
     hereby imposed on every employer an excise tax, with respect 
     to having individuals in his employ, equal to 8.7 percent of 
     the wages (as defined in section 3121(a)) paid by him with 
     respect to employment (as defined in section 3121(b)).''.
       (b) Self-Employment Income.--section 1401 (relating to rate 
     of tax on self-employment income) is amended by redesignating 
     subsection (c) as subsection (d) and inserting after 
     subsection (b) the following new subsection:
       ``(c) Health Care.--In addition to other taxes, there shall 
     be imposed for each taxable year, on the self-employment 
     income of every individual, a tax equal to 8.7 percent of the 
     amount of the self-employment income for such taxable 
     year.''.
       (c) Comparable Taxes for Railroad Services.--
       (1) Tax on employers.--Section 3221 is amended by 
     redesignating subsection (c) as subsections (d) and inserting 
     after subsection (b) the following new subsection:
       ``(c) Health Care.--In addition to other taxes, there is 
     hereby imposed on every employer an excise tax, with respect 
     to having individuals in his employ, equal to 8.7 percent of 
     the compensation paid by such employer for services rendered 
     to such employer.''.
       (2) Tax on employee representatives.--Section 3211 
     (relating to tax on employee representatives) is amended by 
     redesignating subsection (c) as subsection (d) and inserting 
     after subsection (b) the following new paragraph:
       ``(c) Health Care.--In addition to other taxes, there is 
     hereby imposed on the income of each employee representative 
     a tax equal to 8.7 percent of the compensation received 
     during the calendar year by such employee representative for 
     services rendered by such employee representative.''.
       (3) No applicable base.--Subparagraph (A) of section 
     3231(e)(2) is amended by adding at the end thereof the 
     following new clause:
       ``(iv) Health care taxes.--Clause (i) shall not apply to 
     the taxes imposed by sections 3221(c) and 3211(c).''.
       (4) Technical amendment.--
       (A) Subsection (d) of section 3211, as redesignated by 
     paragraph (2), is amended by striking ``and (b)'' and 
     inserting ``, (b), and (c)''.
       (B) Subsection (d) of section 3221, as redesignated by 
     paragraph (1), is amended by striking ``and (b)'' and 
     inserting ``, (b), and (c)''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to remuneration paid after December 31, 2010.

     SEC. 1536. HEALTH CARE INCOME TAX.

       (a) General Rule.--Subchapter A of chapter 1 (relating to 
     determination of tax liability) is amended by adding at the 
     end thereof the following new part:

           ``PART VIII--HEALTH CARE INCOME TAX ON INDIVIDUALS

``Sec. 59B. Health care income tax.

     ``SEC. 59B. HEALTH CARE INCOME TAX.

       ``(a) Imposition of Tax.--In the case of an individual, 
     there is hereby imposed a tax (in addition to any other tax 
     imposed by this subtitle) equal to 2.2 percent of the taxable 
     income of the taxpayer for the taxable year.
       ``(b) No Credits Against Tax; No Effect on Minimum Tax.--
     The tax imposed by this section shall not be treated as a tax 
     imposed by this chapter for purposes of determining--
       ``(1) the amount of any credit allowable under this 
     chapter, or
       ``(2) the amount of the minimum tax imposed by section 55.
       ``(c) Special Rules.--
       ``(1) Tax to be withheld, etc.--For purposes of this title, 
     the tax imposed by this section shall be treated as imposed 
     by section 1.
       ``(2) Reimbursement of tax by employer not includible in 
     gross income.--The gross income of an employee shall not 
     include any payment by his employer to reimburse the employee 
     for the tax paid by the employee under this section.
       ``(3) Other rules.--The rules of section 59A(d) shall apply 
     to the tax imposed by this section.''.
       (b) Clerical Amendment.--The table of parts for subchapter 
     A of chapter 1 is amended by adding at the end the following 
     new item:

         ``Part VIII--Health Care Income Tax on Individuals''.

       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2010.

  Subtitle H--Conforming Amendments to the Employee Retirement Income 
                          Security Act of 1974

     SEC. 1601. ERISA INAPPLICABLE TO HEALTH COVERAGE ARRANGEMENTS 
                   UNDER STATE HEALTH SECURITY PROGRAMS.

       Section 4 of the Employee Retirement Income Security Act of 
     1974 (29 U.S.C. 1003) is amended--
       (1) in subsection (a), by striking ``(b) or (c)'' and 
     inserting ``(b), (c), or (d)''; and
       (2) by adding at the end the following new subsection:
       ``(d) The provisions of this title shall not apply to any 
     arrangement forming a part of a State health security program 
     established pursuant to section 1001(b) of the American 
     Health Security Act of 2009.''.

     SEC. 1602. EXEMPTION OF STATE HEALTH SECURITY PROGRAMS FROM 
                   ERISA PREEMPTION.

       Section 514(b) of the Employee Retirement Income Security 
     Act of 1974 (29 U.S.C. 1144(b)) (as amended by sections 
     174(b)(3)(B) and 182(b) of this title) is amended by adding 
     at the end the following new paragraph:
       ``(8) Subsection (a) of this section shall not apply to 
     State health security programs established pursuant to 
     section 1001(b) of the American Health Security Act of 
     2009.''.

     SEC. 1603. PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF 
                   BENEFITS UNDER STATE HEALTH SECURITY PROGRAMS; 
                   COORDINATION IN CASE OF WORKERS' COMPENSATION.

       (a) In General.--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 new section:


``prohibition of employee benefits duplicative of state health security 
    program benefits; coordination in case of workers' compensation

       ``Sec. 519.  (a) Subject to subsection (b), no employee 
     benefit plan may provide benefits

[[Page S12187]]

     which duplicate payment for any items or services for which 
     payment may be made under a State health security program 
     established pursuant to section 1001(b) of the American 
     Health Security Act of 2009.
       ``(b)(1) Each workers compensation carrier that is liable 
     for payment for workers compensation services furnished in a 
     State shall reimburse the State health security plan for the 
     State in which the services are furnished for the cost of 
     such services.
       ``(2) In this subsection:
       ``(A) The term `workers compensation carrier' means an 
     insurance company that underwrites workers compensation 
     medical benefits with respect to 1 or more employers and 
     includes an employer or fund that is financially at risk for 
     the provision of workers compensation medical benefits.
       ``(B) The term `workers compensation medical benefits' 
     means, with respect to an enrollee who is an employee subject 
     to the workers compensation laws of a State, the 
     comprehensive medical benefits for work-related injuries and 
     illnesses provided for under such laws with respect to such 
     an employee.
       ``(C) The term `workers compensation services' means items 
     and services included in workers compensation medical 
     benefits and includes items and services (including 
     rehabilitation services and long-term-care services) commonly 
     used for treatment of work-related injuries and illnesses.''.
       (b) Conforming Amendment.--Section 4(b) of such Act (29 
     U.S.C. 1003(b)) is amended by adding at the end the 
     following: ``Paragraph (3) shall apply subject to section 
     519(b) (relating to reimbursement of State health security 
     plans by workers compensation carriers).''.
       (c) Clerical Amendment.--The table of contents in section 1 
     of such Act is amended by inserting after the item relating 
     to section 518 the following new items:

``Sec. 519. Prohibition of employee benefits duplicative of state 
              health security program benefits; coordination in case of 
              workers' compensation.''.

     SEC. 1604. REPEAL OF CONTINUATION COVERAGE REQUIREMENTS UNDER 
                   ERISA AND CERTAIN OTHER REQUIREMENTS RELATING 
                   TO GROUP HEALTH PLANS.

       (a) In General.--Part 6 of subtitle B of title I of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1161 et seq.) is repealed.
       (b) Conforming Amendments.--
       (1) Section 502(a) of such Act (29 U.S.C. 1132(a)) is 
     amended--
       (A) by striking paragraph (7); and
       (B) by redesignating paragraphs (8), (9), and (10) as 
     paragraphs (7), (8), and (9), respectively.
       (2) Section 502(c)(1) of such Act (29 U.S.C. 1132(c)(1)) is 
     amended by striking ``paragraph (1) or (4) of section 606,''.
       (3) Section 514(b) of such Act (29 U.S.C. 1144(b)) is 
     amended--
       (A) in paragraph (7), by striking ``section 
     206(d)(3)(B)(i)),'' and all that follows and inserting 
     ``section 206(d)(3)(B)(i)).''; and
       (B) by striking paragraph (8).
       (4) The table of contents in section 1 of the Employee 
     Retirement Income Security Act of 1974 is amended by striking 
     the items relating to part 6 of subtitle B of title I of such 
     Act.

     SEC. 1605. EFFECTIVE DATE OF SUBTITLE.

       The amendments made by this subtitle shall take effect 
     January 1, 2012.

              Subtitle I--Additional Conforming Amendments

     SEC. 1701. REPEAL OF CERTAIN PROVISIONS IN INTERNAL REVENUE 
                   CODE OF 1986.

       The provisions of titles III and IV of the Health Insurance 
     Portability and Accountability Act of 1996, other than 
     subtitles D and H of title III and section 342, are repealed 
     and the provisions of law that were amended or repealed by 
     such provisions are hereby restored as if such provisions had 
     not been enacted.

     SEC. 1702. REPEAL OF CERTAIN PROVISIONS IN THE EMPLOYEE 
                   RETIREMENT INCOME SECURITY ACT OF 1974.

       (a) In General.--Part 7 of subtitle B of title I of the 
     Employee Retirement Income Security Act of 1974 is repealed 
     and the items relating to such part in the table of contents 
     in section 1 of such Act are repealed.
       (b) Conforming Amendment.--Section 514(b) of such Act (29 
     U.S.C. 1144(b)) is amended by striking paragraph (9).

     SEC. 1703. REPEAL OF CERTAIN PROVISIONS IN THE PUBLIC HEALTH 
                   SERVICE ACT AND RELATED PROVISIONS.

       (a) In General.--Titles XXII and XXVII of the Public Health 
     Service Act are repealed.
       (b) Additional Amendments.--
       (1) Section 1301(b) of such Act (42 U.S.C. 300e(b)) is 
     amended by striking paragraph (6).
       (2) Sections 104 and 191 of the Health Insurance 
     Portability and Accountability Act of 1996 are repealed.

     SEC. 1704. EFFECTIVE DATE OF SUBTITLE.

       The amendments made by this title shall take effect January 
     1, 2013.

               TITLE II--HEALTH CARE QUALITY IMPROVEMENTS

     SEC. 2001. HEALTH CARE DELIVERY SYSTEM RESEARCH; QUALITY 
                   IMPROVEMENT TECHNICAL ASSISTANCE.

       Title IX of the 5 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 PROGRAMS

     ``SEC. 931. 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) General Functions of the Center.--The Center for 
     Quality Improvement and Patient Safety of the Agency for 
     Healthcare Research and Quality (referred to in this section 
     as the `Center'), or any other relevant agency or department 
     designated by the Director, 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 consistent with the 
     purposes described 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).
       ``(c) 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

[[Page S12188]]

     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 concerns identified by health care 
     institutions and providers and communicated through the 
     Center pursuant to subsection (d);
       ``(B) reduce preventable morbidity, mortality, and 
     associated costs of morbidity and mortality by building 
     capacity for patient safety research;
       ``(C) 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;
       ``(D) 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;
       ``(E) 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;
       ``(F) 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;
       ``(G) 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
       ``(H) include the examination of how to measure and 
     evaluate the progress of quality and patient safety 
     activities.
       ``(d) 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.
       ``(e) 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) the 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) the potential impact of such processes or systems on 
     health status and function of patients, including vulnerable 
     populations including children;
       ``(5) the areas of insufficient evidence identified under 
     subsection (c)(2)(B); and
       ``(6) the evolution of meaningful use of health information 
     technology, as defined in section 3000.
       ``(f) Funding.--There is authorized to be appropriated to 
     carry out this section $20,000,000 for fiscal years 2010 
     through 2014.

     ``SEC. 932. QUALITY IMPROVEMENT TECHNICAL ASSISTANCE AND 
                   IMPLEMENTATION.

       ``(a) In General.--The Director, through the Center for 
     Quality Improvement and Patient Safety of the Agency for 
     Healthcare Research and Quality (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 (including 
     rural and urban providers of services and suppliers with 
     limited infrastructure and financial resources to implement 
     and support quality improvement activities, providers of 
     services and suppliers with poor performance scores, and 
     providers of services and suppliers for which there are 
     disparities in care among subgroups of patients) 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 
     399W, 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 931;
       ``(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 399W regarding the dissemination of 
     quality improvement, system delivery reform, and best 
     practices information.''.

     SEC. 2002. ESTABLISHING 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 or enter into 
     contracts with eligible entities to establish

[[Page S12189]]

     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 or contracts 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 
     or contract 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, pharmacists, 
     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;
       (5) agree to provide services to eligible individuals with 
     chronic conditions in accordance with the payment methodology 
     established under subsection (c) of such section; and
       (6) 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 or contract under subsection 
     (a) shall--
       (1) establish contractual agreements with primary care 
     providers to provide support services;
       (2) support patient-centered medical homes, defined as a 
     mode of care that includes--
       (A) personal physicians;
       (B) whole person orientation;
       (C) coordinated and integrated care;
       (D) safe and high-quality care through 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; and
       (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.
       (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 or contract 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. 2003. 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 2001, is further amended by 
     inserting after section 932 the following:

     ``SEC. 933. GRANTS OR CONTRACTS 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 931 
     (referred to in this section as the `Center'), shall 
     establish a program to provide grants or contracts 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 program under this 
     section not later than May 1, 2010.
       ``(b) Eligible Entities.--To be eligible to receive a grant 
     or contract 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 3502 of the Patient Protection and Affordable Care 
     Act or in collaboration with primary care extension programs 
     established in section 399W;
       ``(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 or contract 
     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;

[[Page S12190]]

       ``(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 or contract 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 or contracts 
     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 or contract 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 by the entity with a 
     contract under section 1890 of the Social Security Act, 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) Grants or Contracts to Fund Development of 
     Performance Measures.--The Secretary may 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. 2004. 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

[[Page S12191]]

     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 Patient 
     Protection and Affordable Care 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. 2005. PROGRAM TO FACILITATE SHARED DECISIONMAKING.

       Part D of title IX of the Public Health Service Act, as 
     amended by section 2003, is further amended by adding at the 
     end the following:

     ``SEC. 934. 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 entity with a contract under section 1890 
     of the Social Security Act. 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

[[Page S12192]]

     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 Decisionmaking 
     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 Decisionmaking 
     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 decisionmaking 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 and to assess the use of 
     such 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 Decisionmaking 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.
       ``(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. 2006. 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 decisionmaking 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. 2007. 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. 2008. IMPROVING 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.--

[[Page S12193]]

       ``(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 
     of 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.

[[Page S12194]]

       ``(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. 2009. PATIENT NAVIGATOR PROGRAM.

       Section 340A of the Public Health Service Act (42 U.S.C. 
     256a) is amended--
       (1) by striking subsection (d)(3) and inserting the 
     following:
       ``(3) Limitations on grant period.--In carrying out this 
     section, the Secretary shall ensure that the total period of 
     a grant does not exceed 4 years.'';
       (2) 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
       (3) 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. 2010. AUTHORIZATION OF APPROPRIATIONS.

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

  TITLE III--PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH

  Subtitle A--Modernizing Disease Prevention and Public Health Systems

     SEC. 3001. NATIONAL PREVENTION, HEALTH PROMOTION AND PUBLIC 
                   HEALTH COUNCIL.

       (a) Establishment.--The President shall establish, within 
     the Department of Health and Human Services, 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 the Surgeon 
     General 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 Secretary of Transportation;
       (6) the Secretary of Labor;
       (7) the Secretary of Homeland Security;
       (8) the Administrator of the Environmental Protection 
     Agency;
       (9) the Director of the Office of National Drug Control 
     Policy;
       (10) the Director of the Domestic Policy Council;
       (11) the Assistant Secretary for Indian Affairs;
       (12) the Chairman of the Corporation for National and 
     Community Service; and
       (13) 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) Advisory Group.--
       (1) In general.--The President shall establish an Advisory 
     Group to the Council to be known as the ``Advisory Group on 
     Prevention, Health Promotion, and Integrative and Public 
     Health'' (hereafter referred to in this section as the 
     ``Advisory Group''). The Advisory Group shall be within the 
     Department of Health and Human Services and report to the 
     Surgeon General.
       (2) Composition.--
       (A) In general.--The Advisory Group shall be composed of 
     not more than 25 non-Federal members to be appointed by the 
     President.
       (B) Representation.--In appointing members under 
     subparagraph (A), the President shall ensure that the 
     Advisory Group includes a diverse group of licensed health 
     professionals, including integrative health practitioners who 
     have expertise in--
       (i) worksite health promotion;
       (ii) community services, including community health 
     centers;
       (iii) preventive medicine;
       (iv) health coaching;
       (v) public health education;
       (vi) geriatrics; and
       (vii) rehabilitation medicine.
       (3) Purposes and duties.--The Advisory Group shall develop 
     policy and program recommendations and advise the Council on 
     lifestyle-based chronic disease prevention and management, 
     integrative health care practices, and health promotion.
       (g) 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

[[Page S12195]]

       (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.
       (h) 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, 
     appropriate exercise, mental health, behavioral health, 
     substance use disorder, and domestic violence screenings) 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; and
       (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).
       (i) 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.

     SEC. 3002. 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, $500,000,000;
       (2) for fiscal year 2011, $750,000,000;
       (3) for fiscal year 2012, $1,000,000,000;
       (4) for fiscal year 2013, $1,250,000,000;
       (5) for fiscal year 2014, $1,500,000,000; and
       (6) for fiscal year 2015, and each fiscal year thereafter, 
     $2,000,000,000.
       (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 as 
     the Community Transformation grant program, the Education and 
     Outreach Campaign for Preventive Benefits, and immunization 
     programs.
       (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. 3003. 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.--
       (1) In general.--Part P of title III of the Public Health 
     Service Act, as amended by paragraph (2), is amended by 
     adding at the end the following:

     ``SEC. 399U. 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;

[[Page S12196]]

       ``(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.''.
       (2) Technical amendments.--
       (A) 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.
       (B) 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. 3004. 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 the American Health Security Program;
       (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) Media Campaign.--
       (1) In general.--Not later than 1 year after the date of 
     enactment of this Act, 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) Requirement 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.
       (d) 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.
       (e) 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.
       (f) 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.
       (g) Internet Portal.--The Secretary shall establish an 
     Internet portal for accessing risk-assessment tools developed 
     and maintained by private and academic entities.
       (h) 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.
       (i) Public Awareness of Preventive and Obesity-Related 
     Services.--
       (1) Information to states.--The Secretary of Health and 
     Human Services shall provide guidance and relevant 
     information to States and health care providers regarding 
     preventive and obesity-related services that are available 
     through the American Health Security Program.
       (2) Information to enrollees.--Each State shall design a 
     public awareness campaign regarding availability and coverage 
     of such services, with the goal of reducing incidences of 
     obesity.
       (3) Report.--Not later than January 1, 2011, and every 3 
     years thereafter through January 1, 2017, the Secretary of 
     Health and Human Services shall report to Congress on the 
     status and effectiveness of efforts under paragraphs (1) and 
     (2), including summaries of the States' efforts to increase 
     awareness of coverage of obesity-related services.
       (j) 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. 3101. SCHOOL-BASED HEALTH CENTERS.

       (a) Grants for the Establishment of School-Based Health 
     Centers.--
       (1) Program.--The Secretary of Health and Human Services 
     (in this subsection referred to as the ``Secretary'') shall 
     establish a program to award grants to eligible entities to 
     support the operation of school-based health centers.
       (2) Eligibility.--To be eligible for a grant under this 
     subsection, an entity shall--
       (A) be a school-based health center or a sponsoring 
     facility of a school-based health center; and
       (B) submit an application at such time, in such manner, and 
     containing such information as the Secretary may require, 
     including at a minimum an assurance that funds awarded under 
     the grant shall not be used to provide any service that is 
     not authorized or allowed by Federal, State, or local law.
       (3) Limitation on use of funds.--An eligible entity shall 
     use funds provided under a grant awarded under this 
     subsection only for expenditures for facilities (including 
     the acquisition or improvement of land, or the acquisition, 
     construction, expansion, replacement, or other improvement of 
     any building or other facility), equipment, or similar 
     expenditures, as specified by the Secretary. No funds 
     provided under a grant awarded under this section shall be 
     used for expenditures for personnel or to provide health 
     services.
       (4) Appropriations.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated for each of 
     fiscal years 2010 through 2013, $50,000,000 for the purpose 
     of carrying out this subsection. Funds appropriated under 
     this paragraph shall remain available until expended.
       (5) Definitions.--In this subsection, the terms ``school-
     based health center'' and ``sponsoring facility'' have the 
     meanings given those terms in section 2110(c)(9) of the 
     Social Security Act (42 U.S.C. 1397jj(c)(9)).
       (b) Grants for the Operation of School-Based Health 
     Centers.--Part Q of title III of the Public Health Service 
     Act (42 U.S.C.

[[Page S12197]]

     280h et seq.) is amended by adding at the end the following:

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

       ``(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 centers, 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, the accessibility 
     of health services, the availability of health professionals 
     to such children and adolescents, and other factors as 
     determined appropriate by the Secretary.
       ``(3) School-based health center.--The term `school-based 
     health center' means a health clinic that--
       ``(A) meets the definition of a school-based health center 
     under section 2110(c)(9)(A) of the Social Security Act and is 
     administered by a sponsoring facility (as defined in section 
     2110(c)(9)(B) of the Social Security Act);
       ``(B) 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; and
       ``(C) does not perform abortion services.
       ``(b) Authority to Award Grants.--The Secretary shall award 
     grants for the costs of the operation of school-based health 
     centers (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)(3)); 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 and Consideration.--In reviewing 
     applications:
       ``(1) The Secretary may give preference to applicants who 
     demonstrate an ability to serve the following:
       ``(A) Communities that have evidenced barriers to primary 
     health care and mental health and substance use disorder 
     prevention services for children and adolescents.
       ``(B) Populations of children and adolescents that have 
     historically demonstrated difficulty in accessing health and 
     mental health and substance use disorder prevention services.
       ``(2) The Secretary may give consideration to whether an 
     applicant has received a grant under subsection (a) of 
     section 3101 of the Patient Protection and Affordable Care 
     Act.
       ``(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--
       ``(A) may be used for--
       ``(i) acquiring and leasing equipment (including the costs 
     of amortizing the principle of, and paying interest on, loans 
     for such equipment);
       ``(ii) providing training related to the provision of 
     required comprehensive primary health services and additional 
     health services;
       ``(iii) the management and operation of health center 
     programs;
       ``(iv) the payment of salaries for physicians, nurses, and 
     other personnel of the SBHC; and
       ``(B) may not be used to provide abortions.
       ``(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) Limitations.--
       ``(A) In general.--Any provider of services that is 
     determined by a State to be in violation of a State law 
     described in subsection (a)(3)(B) with respect to activities 
     carried out at a SBHC shall not be eligible to receive 
     additional funding under this section.
       ``(B) No overlapping grant period.--No entity that has 
     received funding under section 330 for a grant period shall 
     be eligible for a grant under this section for with respect 
     to the same grant period.
       ``(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) Evaluation.--The Secretary shall develop and 
     implement a plan for evaluating SBHCs and monitoring quality 
     performance under the awards made under this section.
       ``(j) 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.
       ``(k) Parental Consent.--An eligible entity receiving funds 
     under this section shall not provide services through a SBHC 
     funded under this section to an individual without the 
     consent of the parent or guardian of such individual if such 
     individual is considered a minor under applicable State law.
       ``(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. 3102. 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 T--ORAL HEALTHCARE PREVENTION ACTIVITIES

     ``SEC. 399LL. 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

[[Page S12198]]

     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. 399LL-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 399LL.

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

       ``There is authorized to be appropriated to carry out this 
     part, such sums as may be necessary.''.
       (b) 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)''.
       (c) 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.''.
       (d) 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. 3201. 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, prevent the 
     development of secondary conditions, 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) a local governmental agency;
       (C) a national network of community-based organizations;
       (D) a State or local non-profit organization; or
       (E) an 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 within and beyond health care and 
     across a community, such as healthy futures corps and health 
     care providers.
       (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, emotional 
     wellness, 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, improve social and emotional 
     wellness, 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, economic, and geographic 
     determinants of health; and
       (vii) addressing special populations needs, including all 
     age groups and individuals with disabilities, and individuals 
     in both urban and rural areas.
       (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 may 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;

[[Page S12199]]

       (v) changes in emotional well-being and overall mental 
     health;
       (vi) other factors using community-specific data from the 
     Behavioral Risk Factor Surveillance Survey; and
       (vii) 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 
     and the link between physical, emotional, and social well-
     being.
       (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. 3202. HEALTHY AGING, LIVING WELL; EVALUATION OF 
                   COMMUNITY-BASED PREVENTION AND WELLNESS 
                   PROGRAMS.

       (a) Healthy Aging, Living Well.--
       (1) 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.
       (2) Eligibility.--To be eligible to receive a grant under 
     paragraph (1), an entity shall--
       (A) be--
       (i) a State health department;
       (ii) a local health department; or
       (iii) an Indian tribe;
       (B) 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;
       (C) design a strategy for improving the health of the 55-
     to-64 year-old population through community-based public 
     health interventions; and
       (D) 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 paragraph (3), such 
     relationships to include the identification of a community-
     based clinical partner, such as a community health center or 
     rural health clinic.
       (3) Use of funds.--
       (A) In general.--A State or local health department shall 
     use amounts received under a grant under this subsection to 
     carry out a program to provide the services described in this 
     paragraph to individuals who are between 55 and 64 years of 
     age.
       (B) Public health interventions.--
       (i) 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.
       (ii) Types of intervention activities.--Intervention 
     activities conducted under this subparagraph 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.
       (C) Community preventive screenings.--
       (i) 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 
     subsection to conduct ongoing health screening to identify 
     risk factors for cardiovascular disease, cancer, stroke, and 
     diabetes among individuals in both urban and rural areas who 
     are between 55 and 64 years of age.
       (ii) Types of screening activities.--Screening activities 
     conducted under this subparagraph 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.

       (iii) Monitoring.--Grantees under this section shall 
     maintain records of screening results under this subparagraph 
     to establish the baseline data for monitoring the targeted 
     population
       (D) Clinical referral/treatment for chronic diseases.--
       (i) In general.--A State or local health department shall 
     use amounts received under a grant under this subsection 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 subparagraph (C)(ii), 
     receive clinical referral/treatment for follow-up services to 
     reduce such risk.
       (ii) Public health intervention program.--A State or local 
     health department shall use amounts received under a grant 
     under this subsection 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.
       (E) Grantee evaluation.--An eligible entity shall use 
     amounts provided under a grant under this subsection to 
     conduct activities to measure changes in the prevalence of 
     chronic disease risk factors among participants.
       (4) Pilot program evaluation.--The Secretary shall conduct 
     an annual evaluation of the effectiveness of the pilot 
     program under this subsection. In determining such 
     effectiveness, the Secretary shall consider changes in the 
     prevalence of uncontrolled chronic disease risk factors among 
     individuals who are 63 years of age and older 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.
       (5) Authorization of appropriations.--There are authorized 
     to be appropriated to carry out this subsection, such sums as 
     may be necessary for each of fiscal years 2010 through 2014.
       (b) Evaluation and Plan for Community-Based Prevention and 
     Wellness Programs.--
       (1) In general.--The Secretary shall conduct an evaluation 
     of community-based prevention and wellness programs and 
     develop a plan for promoting healthy lifestyles and chronic 
     disease self-management for individuals who are 65 years of 
     age and older.
       (2) Evaluation of prevention and wellness programs.--
       (A) In general.--The Secretary shall evaluate community 
     prevention and wellness programs including those that are 
     sponsored by the Administration on Aging, are evidence-based, 
     and have demonstrated potential to help individuals who are 
     65 years of age and oldervreduce their risk of disease, 
     disability, and injury by making healthy lifestyle choices, 
     including exercise, diet, and self-management of chronic 
     diseases.
       (B) Evaluation.--The evaluation under subparagraph (A) 
     shall consist of the following:
       (i) Evidence review.--The Secretary shall review available 
     evidence, literature, best practices, and resources that are 
     relevant to programs that promote healthy lifestyles and 
     reduce risk factors for individuals who are 65 years of age 
     and older. The Secretary may determine the scope of the 
     evidence review and such issues to be considered, which shall 
     include, at a minimum--

       (I) physical activity, nutrition, and obesity;
       (II) falls;
       (III) chronic disease self-management; and
       (IV) mental health.

       (ii) Independent evaluation of evidence-based community 
     prevention and wellness programs.--The Assistant Secretary 
     for Aging, shall, to the extent feasible and practicable, 
     conduct an evaluation of existing community prevention and 
     wellness programs that are sponsored by the Administration on 
     Aging to assess the extent to which individuals who are 65 
     years of age and older participate in such programs--

       (I) reduce their health risks, improve their health 
     outcomes, and adopt and maintain healthy behaviors; and
       (II) improve their ability to manage their chronic 
     conditions.

       (3) Report.--Not later than September 30, 2013, the 
     Secretary shall submit to Congress a report that includes--
       (A) recommendations for such legislation and administrative 
     action as the Secretary determines appropriate to promote 
     healthy lifestyles and chronic disease self-management for 
     individuals aged 65 and older;
       (B) any relevant findings relating to the evidence review 
     under paragraph (2)(B)(i); and
       (C) the results of the evaluation under paragraph 
     (2)(B)(ii).
       (4) Funding.--For purposes of carrying out this subsection, 
     the Secretary shall provide for the transfer, from the 
     Federal Hospital Insurance Trust Fund under section 1817 of 
     the Social Security Act (42 U.S.C. 1395i) and the Federal 
     Supplemental Medical Insurance Trust Fund under section 1841 
     of such Act (42 U.S.C. 1395t), in such proportion as the 
     Secretary determines appropriate, of $50,000,000 to the 
     Centers for Medicare & Medicaid Services Program Management 
     Account. Amounts transferred under the preceding sentence 
     shall remain available until expended.
       (5) Administration.--Chapter 35 of title 44, United States 
     Code shall not apply to the this subsection.

[[Page S12200]]

     SEC. 3203. REMOVING BARRIERS AND IMPROVING ACCESS TO 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 Patient Protection and Affordable Care 
     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. 3204. 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 Patient Protection and Affordable 
     Care 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. 3205. NUTRITION LABELING OF STANDARD MENU ITEMS AT CHAIN 
                   RESTAURANTS.

       (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

[[Page S12201]]

     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. 3206. 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) Demonstration 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 well
     ness 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. 3207. 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.
       ``(4) Nothing in this subsection shall preempt a State law 
     that provides greater protections to employees than the 
     protections provided for under this subsection.''.

    Subtitle D--Support for Prevention and Public Health Innovation

     SEC. 3301. 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--

[[Page S12202]]

       (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. 3302. UNDERSTANDING HEALTH DISPARITIES: DATA COLLECTION 
                   AND ANALYSIS.

       (a) Uniform Categories and Collection Requirements.--The 
     Public Health Service Act (42 U.S.C. 201 et seq.) is amended 
     by adding at the end the following:

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

     ``SEC. 3101. DATA COLLECTION, ANALYSIS, AND QUALITY.

       ``(a) Data Collection.--
       ``(1) In general.--The Secretary shall ensure that, by not 
     later than 2 years after the date of enactment of this title, 
     any federally conducted or supported health care or public 
     health program, activity or survey (including Current 
     Population Surveys and American Community Surveys conducted 
     by the Bureau of Labor Statistics and the Bureau of the 
     Census) collects and reports, to the extent practicable--
       ``(A) data on race, ethnicity, sex, primary language, and 
     disability status for applicants, recipients, or 
     participants;
       ``(B) data at the smallest geographic level such as State, 
     local, or institutional levels if such data can be 
     aggregated;
       ``(C) sufficient data to generate statistically reliable 
     estimates by racial, ethnic, sex, primary language, and 
     disability status subgroups for applicants, recipients or 
     participants using, if needed, statistical oversamples of 
     these subpopulations; and
       ``(D) 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 sex, primary 
     language, and disability status;
       ``(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 participant; and
       ``(ii) collects data from a parent or legal guardian if the 
     applicant, recipient, or participant is a minor or legally 
     incapacitated;
       ``(D) survey health care providers and establish other 
     procedures in order to assess access to care and treatment 
     for individuals with disabilities and to identify--
       ``(i) locations where individuals with disabilities access 
     primary, acute (including intensive), and long-term care;
       ``(ii) the number of providers with accessible facilities 
     and equipment to meet the needs of the individuals with 
     disabilities, including medical diagnostic equipment that 
     meets the minimum technical criteria set forth in section 510 
     of the Rehabilitation Act of 1973; and
       ``(iii) the number of employees of health care providers 
     trained in disability awareness and patient care of 
     individuals with disabilities; and
       ``(E) require that any reporting requirement imposed for 
     purposes of measuring quality under any ongoing or federally 
     conducted or supported health care or public health program, 
     activity, or survey includes requirements for the collection 
     of data on individuals receiving health care items or 
     services under such programs activities by race, ethnicity, 
     sex, primary language, and disability status.
       ``(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 for purposes of 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 Indian Health Service and epidemiology centers 
     funded under the Indian Health Care Improvement Act;
       ``(F) the Office of Rural health;
       ``(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, in accordance with any 
     Federal agency's data user agreements.
       ``(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 and Sharing of Data.--
       ``(1) Privacy and other safeguards.--The Secretary shall 
     ensure (through the promulgation of regulations or otherwise) 
     that--
       ``(A) all data collected pursuant to subsection (a) is 
     protected--
       ``(i) under 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
       ``(ii) 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; and
       ``(B) all appropriate information security safeguards are 
     used in the collection, analysis, and sharing of data 
     collected pursuant to subsection (a).
       ``(2) Data sharing.--The Secretary shall establish 
     procedures for sharing data collected pursuant to subsection 
     (a), measures relating to such data, and analyses of such 
     data, with other relevant Federal and State agencies 
     including the agencies, centers, and entities within the 
     Department of Health and Human Services specified in 
     subsection (c)(1).
       ``(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 are 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.
       ``(i) Consultation.--The Secretary shall consult with the 
     Director of the Office of Personnel Management, the Secretary 
     of Defense, the Secretary of Veterans Affairs, the Director 
     of the Bureau of the Census, the Commissioner of Social 
     Security, and the head of other appropriate Federal agencies 
     in carrying out this section.''.

     SEC. 3303. CDC AND EMPLOYER-BASED WELLNESS PROGRAMS.

       Title III of the Public Health Service Act (42 U.S.C. 241 
     et seq.), by section 3102, is further amended by adding at 
     the end the following:

               ``PART U--EMPLOYER-BASED WELLNESS PROGRAM

     ``SEC. 399MM. 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

[[Page S12203]]

     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. 399MM-1. 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. 399MM-2. 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. 399MM-3. 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. 3304. 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 State health departments as well 
     as local health departments and tribal jurisdictions that 
     meet such criteria as the Director determines appropriate. 
     Academic centers that assist State and eligible local and 
     tribal health departments may also be eligible for funding 
     under this section as the Director determines appropriate. 
     Grants shall be awarded under this section 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 to identify and 
     monitor the occurrence of infectious diseases and other 
     conditions of public health importance;
       ``(2) enhancing laboratory practice as well as systems to 
     report test orders and results electronically;
       ``(3) improving information systems including developing 
     and maintaining an information exchange using national 
     guidelines and complying with capacities and functions 
     determined by an advisory council established and appointed 
     by the Director; and
       ``(4) developing and implementing prevention and control 
     strategies.
       ``(b) 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 paragraphs (1) and 
     (4) of subsection (a);
       ``(2) not less than $60,000,000 shall be made available 
     each such fiscal year for activities under subsection (a)(3); 
     and
       ``(3) not less than $32,000,000 shall be made available 
     each such fiscal year for activities under subsection 
     (a)(2).''.

     SEC. 3305. ADVANCING RESEARCH AND TREATMENT FOR PAIN CARE 
                   MANAGEMENT.

       (a) Institute of Medicine Conference on Pain.--
       (1) Convening.--Not later than 1 year after funds are 
     appropriated to carry out this subsection, 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 subsection 
     referred to as ``the Conference'').
       (2) Purposes.--The purposes of the Conference shall be to--
       (A) increase the recognition of pain as a significant 
     public health problem in the United States;
       (B) 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;
       (C) identify barriers to appropriate pain care;
       (D) 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.
       (3) Other appropriate entity.--If the Institute of Medicine 
     declines to enter into an agreement under paragraph (1), the 
     Secretary of Health and Human Services may enter into such 
     agreement with another appropriate entity.
       (4) Report.--A report summarizing the Conference's findings 
     and recommendations shall be submitted to the Congress not 
     later than June 30, 2011.
       (5) Authorization of appropriations.--For the purpose of 
     carrying out this subsection, there is authorized to be 
     appropriated such sums as may be necessary for each of fiscal 
     years 2010 and 2011.
       (b) 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 
     appoint by the Secretary from agencies that conduct pain care 
     research and treatment.
       ``(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 non-Federal members shall be appointed from among 
     scientists, physicians, and other health professionals.
       ``(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 
     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 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.''.
       (c) 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) 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--

[[Page S12204]]

       ``(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.
       ``(c) 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.
       ``(d) 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.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of the fiscal years 2010 through 
     2012. Amounts appropriated under this subsection shall remain 
     available until expended.''.

     SEC. 3306. FUNDING FOR CHILDHOOD OBESITY DEMONSTRATION 
                   PROJECT.

       Section 1139A(e)(8) of the Social Security Act (42 U.S.C. 
     1320b-9a(e)(8)) is amended to read as follows:
       ``(8) Appropriation.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to carry out 
     this subsection, $25,000,000 for the period of fiscal years 
     2010 through 2014.''.

                  Subtitle E--Miscellaneous Provisions

     SEC. 3401. 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. 3402. 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. 4001. 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, 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. 4002. DEFINITIONS.

       (a) This Title.--In this title:
       (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.
       (2) 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.
       (3) 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).
       (4) Low income individual, state workforce investment 
     board, and local workforce investment board.--
       (A) Low-income individual.--The term ``low-income 
     individual'' has the meaning given that term in section 101 
     of the Workforce investment Act of 1998 (29 U.S.C. 2801).
       (B) State workforce investment board; local workforce 
     investment board.--The terms ``State workforce investment 
     board'' and ``local workforce investment board'', refer to a 
     State workforce investment board established under section 
     111 of the Workforce Investment Act of 1998 (29 U.S.C. 2821) 
     and a local workforce investment board established under 
     section 117 of such Act (29 U.S.C. 2832), respectively.
       (5) 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.
       (6) 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 (a)(1) or (a)(2) 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 (a)(1) or (a)(2) 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 section 751(c), satisfies the program 
     requirements in such section, has as one of its

[[Page S12205]]

     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. 4101. 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;
       (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 member's 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

[[Page S12206]]

     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) Recognition, dissemination, and communication.--The 
     Commission shall--
       (A) recognize efforts of Federal, State, and local 
     partnerships to develop and offer health care career pathways 
     of proven effectiveness;
       (B) disseminate information on promising retention 
     practices for health care professionals; and
       (C) communicate information on important policies and 
     practices that affect the recruitment, education and 
     training, and retention of the health care workforce.
       (2) 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 (3);
       (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 (4).
       (3) 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;
       (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 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.
       (4) High priority areas.--
       (A) In general.--The initial high priority topics described 
     in this paragraph include each of the following:
       (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) The education and training capacity, projected 
     demands, and integration with the health care delivery system 
     of each of the following:

       (I) Nursing workforce capacity at all levels.
       (II) Oral health care workforce capacity at all levels.
       (III) Mental and behavioral health care workforce capacity 
     at all levels.
       (IV) Allied health and public health care workforce 
     capacity at all levels.
       (V) Emergency medical service workforce capacity, including 
     the retention and recruitment of the volunteer workforce, at 
     all levels.
       (VI) The geographic distribution of health care providers 
     as compared to the identified health care workforce needs of 
     States and regions.

       (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.
       (5) Grant program.--The Commission shall--
       (A) review implementation progress reports on, and report 
     to Congress about, the State Health Care Workforce 
     Development Grant program established in section 4102;
       (B) 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 section 4102(b) for grant 
     recipients under section 4102;
       (C) assess the implementation of the grants under such 
     section; and
       (D) collect performance and report information, including 
     identified models and best practices, on grants from the 
     fiscal and administrative agent under such section and 
     distribute this information to Congress, relevant Federal 
     agencies, and to the public.
       (6) Study.--The Commission shall study effective mechanisms 
     for financing education and training for careers in health 
     care, including public health and allied health.
       (7) 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.
       (8) Assessment.--The Commission shall assess and receive 
     reports from the National Center for Health Care Workforce 
     Analysis established under section 761(b) of the Public 
     Service Health Act (as amended by section 4103).
       (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, 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.

[[Page S12207]]

       (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 and services.--The Commission may not accept 
     gifts, bequeaths, or donations of property, but may accept 
     and use donations of services for purposes 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 and 
     occupational 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 and occupational 
     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.

     SEC. 4102. 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) 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 National Health Care Workforce 
     Commission (referred to in this section as the 
     ``Commission''), which shall review reports on the 
     development, implementation, and evaluation activities of the 
     grant program, including--
       (1) administering the grants;
       (2) providing technical assistance to grantees; and
       (3) 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, 
     including dislocated workers.
       (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

[[Page S12208]]

     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 the potential use of 
     competitive grants to improve the development, distribution, 
     and diversity of the regional health care workforce; the 
     alignment of curricula for health care careers; and the 
     access to quality career information and guidance and 
     education and training opportunities;
       (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 
     regional and State levels, career planning information, 
     retraining for dislocated workers, and as appropriate, 
     requests for Federal program or administrative waivers;
       (iii) develop, disseminate, and review with key 
     stakeholders a preliminary statewide strategy that addresses 
     short- and long-term health care workforce development supply 
     versus demand;
       (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 technical assistance and capacity 
     building activities;
       (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. 4103. HEALTH CARE WORKFORCE 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 National Center, in coordination to 
     the extent practicable with the National Health Care 
     Workforce Commission (established in section 4101 of the 
     Patient Protection and Affordable Care Act), and relevant 
     regional and State centers and agencies, shall--
       ``(A) provide for the development of information describing 
     and analyzing the health care workforce and workforce related 
     issues;
       ``(B) carry out the activities under section 792(a);
       ``(C) annually evaluate programs under this title;
       ``(D) develop and publish performance measures and 
     benchmarks for programs under this title; and
       ``(E) establish, maintain, and publicize a national 
     Internet registry of each grant awarded under this title and 
     a database to collect data from 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)).
       ``(3) Collaboration and data sharing.--
       ``(A) In general.--The National Center shall collaborate 
     with Federal agencies and relevant professional and 
     educational organizations or societies for the purpose of 
     linking data regarding grants awarded under this title.
       ``(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 relevant professional and educational 
     organizations or 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 data regarding 
     programs under this title to the National Center and to the 
     public; and
       ``(B) providing technical assistance to local and regional 
     entities on the collection, analysis, and reporting of data.
       ``(2) Eligible entities.--To be eligible for a grant or 
     contract under this subsection, an entity shall--
       ``(A) be a State, a State workforce investment board, a 
     public health or health professions school, an academic 
     health center, or an appropriate public or private nonprofit 
     entity; 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 
     awarded to an eligible entity under this title for a 
     longitudinal evaluation of individuals who have received 
     education, training, or financial assistance from programs 
     under this title.
       ``(2) Capability.--A longitudinal evaluation shall be 
     capable of--
       ``(A) studying practice patterns; 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
       (3) in subsection (e), as so redesignated--
       (A) by striking paragraph (1) and inserting the following:
       ``(1) In general.--
       ``(A) National center.--To carry out subsection (b), there 
     are authorized to be appropriated $7,500,000 for each of 
     fiscal years 2010 through 2014.
       ``(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.
       ``(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.''; and
       (4) in paragraph (2), by striking ``subsection (a)'' and 
     inserting ``paragraph (1)''.

[[Page S12209]]

       (b) Transfers.--Not later than 180 days after the date of 
     enactment of this Act, the responsibilities and resources of 
     the National Center for Health Workforce Analysis, as in 
     effect on the date before the date of enactment of this Act, 
     shall be transferred to the National Center for Health Care 
     Workforce Analysis established under section 761 of the 
     Public Health Service Act, as amended by subsection (a).
       (c) 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)(2)(E)).''.
       (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) develop, publish, and implement performance measures 
     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) develop, publish, and implement performance measures 
     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) develop, publish, and implement performance measures 
     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. 4201. 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. 4202. 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. 4203. 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 C--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--

[[Page S12210]]

       ``(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. 4204. 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 4203, 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. 4205. 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. 4206. 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 4204, 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

[[Page S12211]]

     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. 4207. 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.''.

     SEC. 4208. NURSE-MANAGED HEALTH CLINICS.

       (a) Purpose.--The purpose of this section is to fund the 
     development and operation of nurse-managed health clinics.
       (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. 4209. 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. 4210. 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 Patient 
     Protection and Affordable Care 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. 4301. 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 4101 of the Patient 
     Protection and Affordable Care Act, which may include--

[[Page S12212]]

       ``(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 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 4101 of the Patient Protection and Affordable Care 
     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. 4302. 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 4301, 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. 4303. 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 4103 
     of this Act, as section 749; and
       (2) inserting after section 747A, as added by section 4302, 
     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

[[Page S12213]]

       ``(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, 
     and in the risk-based clinical disease management of all 
     populations.
       ``(6) Qualified applicants that include educational 
     activities in cultural competency and health literacy.
       ``(7) Qualified applicants that have a high rate for 
     placing graduates in practice settings that serve underserved 
     areas or health disparity populations, or who achieve a 
     significant increase in the rate of placing graduates in such 
     settings.
       ``(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) 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.
       ``(e) 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.
       ``(f) 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.
       ``(g) 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. 4304. 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. 340G-1. 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.--The Secretary shall contract with the 
     Director of the Institute of Medicine 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.
       ``(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. 4305. 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,

[[Page S12214]]

     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.
       ``(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 or have completed specialty training in geriatrics 
     as required by the discipline and any addition geriatrics 
     training as required by the Secretary; 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 make 
     payments to institutions which include schools of medicine, 
     osteopathic medicine, nursing, social work, psychology, 
     dentistry, and pharmacy, or other allied health discipline in 
     an accredited health professions school that is approved by 
     the Secretary.''.
       (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. 4306. 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 4103) 
     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,

[[Page S12215]]

     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 training 
     programs in child and adolescent mental health under 
     subsections (a)(3) and (a)(4), 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 or completion of preservice or in-service 
     training;
       ``(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 
     professionals and paraprofessionals serving high-priority 
     populations and to applicants who come from high-priority 
     communities and plan to serve medically underserved 
     populations, in health professional shortage areas, or in 
     medically underserved areas;
       ``(D) offer curriculum taught collaboratively with a family 
     on the consumer and family lived experience or the importance 
     of family-professional or family-paraprofessional 
     partnerships; 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)(1)(A), 753(b), and 755(b)''.

     SEC. 4307. CULTURAL COMPETENCY, PREVENTION, AND PUBLIC HEALTH 
                   AND INDIVIDUALS WITH DISABILITIES TRAINING.

       (a) Title VII.--Section 741 of the Public Health Service 
     Act (42 U.S.C. 293e) is amended--
       (1) in subsection (a)--
       (A) by striking the subsection heading and inserting 
     ``Cultural Competency, Prevention, and Public Health and 
     Individuals With Disability Grants''; and
       (B) in paragraph (1), by striking ``for the purpose of'' 
     and all that follows through the period at the end and 
     inserting ``for the development, evaluation, and 
     dissemination of research, demonstration projects, and model 
     curricula for cultural competency, prevention, public health 
     proficiency, reducing health disparities, and aptitude for 
     working with individuals with disabilities training for use 
     in health professions schools and continuing education 
     programs, and for other purposes determined as appropriate by 
     the Secretary.''; and
       (2) by striking subsection (b) and inserting the following:
       ``(b) 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. The 
     Secretary shall coordinate with curricula and research and 
     demonstration projects developed under section 807.
       ``(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 may 
     be necessary for each of fiscal years 2010 through 2015.''.
       (b) Title VIII.--Section 807 of the Public Health Service 
     Act (42 U.S.C. 296e-1) is amended--
       (1) in subsection (a)--
       (A) by striking the subsection heading and inserting 
     ``Cultural Competency, Prevention, and Public Health and 
     Individuals With Disability Grants''; and
       (B) by striking ``for the purpose of'' and all that follows 
     through ``health care.'' and inserting ``for the development, 
     evaluation, and dissemination of research, demonstration 
     projects, and model curricula for cultural competency, 
     prevention, public health proficiency, reducing health 
     disparities, and aptitude for working with individuals with 
     disabilities training for use in health professions schools 
     and continuing education programs, and for other purposes 
     determined as appropriate by the Secretary.''; and
       (2) by redesignating subsection (b) as subsection (d);
       (3) by inserting after subsection (a) the following:
       ``(b) Collaboration.--In carrying out subsection (a), the 
     Secretary shall collaborate with the entities described in 
     section 741(b). The Secretary shall coordinate with curricula 
     and research and demonstration projects developed under such 
     section 741.
       ``(c) Dissemination.--Model curricula developed under this 
     section shall be disseminated and evaluated in the same 
     manner as model curricula developed under section 741, as 
     described in subsection (c) of such section.''; and
       (4) in subsection (d), as so redesignated--
       (A) by striking ``subsection (a)'' and inserting ``this 
     section''; and
       (B) by striking ``2001 through 2004'' and inserting ``2010 
     through 2015''.

     SEC. 4308. 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; 
     and
       ``(2) are accredited by the American College of Nurse-
     Midwives Accreditation Commission for Midwifery Education.''.

     SEC. 4309. 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,

[[Page S12216]]

     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.
       ``(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. 4310. 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 
     4305, as section 865; and
       (B) by redesignating part I as part H.

     SEC. 4311. 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. 4312. 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 4310, 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

[[Page S12217]]

     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. 4313. 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.) is amended by adding at 
     the end the following:

     ``SEC. 399V. 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 and provide guidance regarding effective 
     strategies to promote positive health behaviors and 
     discourage risky health behaviors;
       ``(3) to identify, educate, refer, and enroll 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
       ``(4) 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 suffer from 
     chronic diseases; or
       ``(B) 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;
       ``(F) by providing referral and follow-up services or 
     otherwise coordinating care; and
       ``(G) by proactively identifying and enrolling eligible 
     individuals in Federal, State, local, private or nonprofit 
     health and human services programs.
       ``(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.''.

     SEC. 4314. 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 4206, 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. 4315. 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 established in section 4101 of the 
     Patient Protection and Affordable Care Act.
       ``(b) Number of Graduates.--Except as provided in 
     subsection (a), the number of persons to be graduated from 
     the Track shall

[[Page S12218]]

     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 Care 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 Care 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 Care 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 Care Workforce 
     Commission, 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 Care 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 Care Workforce Commission), by 3 months for 
     each year of such participation (not to exceed a total of 12 
     months); and

[[Page S12219]]

       ``(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. 4401. 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. 4402. 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. 4403. 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 
     the following 2 types of awards in accordance with this 
     section:
       ``(1) Infrastructure development award.--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 an area health 
     education center program.
       ``(2) Point of service maintenance and enhancement award.--
     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

[[Page S12220]]

     changes in demographics, needs of the populations served, or 
     other similar issues affecting the area health education 
     center program. For the purposes of this section, the term 
     `Program' refers to the area health education center program.
       ``(b) Eligible Entities; Application.--
       ``(1) Eligible entities.--
       ``(A) Infrastructure development.--For purposes of 
     subsection (a)(1), the term `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 subsection 
     (a)(1) to a school of nursing.
       ``(B) Point of service maintenance and enhancement.--For 
     purposes of subsection (a)(2), the term `eligible entity' 
     means an entity that has received funds under this section, 
     is operating an area health education center program, 
     including an area health education center or centers, and has 
     a center or centers that are no longer eligible to receive 
     financial assistance under subsection (a)(1).
       ``(2) 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.
       ``(c) Use of Funds.--
       ``(1) Required activities.--An eligible entity shall use 
     amounts awarded under a grant under subsection (a)(1) or 
     (a)(2) to carry out the following activities:
       ``(A) 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.
       ``(B) 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.
       ``(C) 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.
       ``(D) 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.
       ``(E) 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.
       ``(F) Propose and implement effective program and outcomes 
     measurement and evaluation strategies.
       ``(G) Establish a youth public health program to expose and 
     recruit high school students into health careers, with a 
     focus on careers in public health.
       ``(2) Innovative opportunities.--An eligible entity may use 
     amounts awarded under a grant under subsection (a)(1) or 
     subsection (a)(2) to carry out any of the following 
     activities:
       ``(A) 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.
       ``(B) 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.
       ``(C) 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 conducts at least 10 percent of 
     clinical education required for nursing students in community 
     settings that are 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 students from that school in training sites in the 
     area health education center program area.
       ``(B) An entity receiving funds under subsection (a)(2) 
     does not distribute such funding to a center that is eligible 
     to receive funding under subsection (a)(1).
       ``(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 (a)(1).
       ``(f) Limitation.--Not less than 75 percent of the total 
     amount provided to an area health education center program 
     under subsection (a)(1) or (a)(2) 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 (a)(1).
       ``(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 (j)(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 (a)(1) 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 (a)(2) 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 (a)(1);
       ``(B) not less than 60 percent shall be used for awards 
     under subsection (a)(2);

[[Page S12221]]

       ``(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. 4404. 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. 4405. 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 4313, is further 
     amended by adding at the end the following:

     ``SEC. 399W. 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 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, including health 
     homes;
       ``(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 2002 of the Patient Protection and Affordable 
     Care 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.

[[Page S12222]]

       ``(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.''.

Subtitle F--Strengthening Primary Care and Other Workforce Improvements

     SEC. 4501. DEMONSTRATION PROJECTS TO ADDRESS HEALTH 
                   PROFESSIONS WORKFORCE NEEDS; EXTENSION OF 
                   FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS.

       (a) Authority to Conduct Demonstration Projects.--Title XX 
     of the Social Security Act (42 U.S.C. 1397 et seq.) is 
     amended by adding at the end the following:

     ``SEC. 2008. DEMONSTRATION PROJECTS TO ADDRESS HEALTH 
                   PROFESSIONS WORKFORCE NEEDS.

       ``(a) Demonstration Projects To Provide Low-Income 
     Individuals With Opportunities for Education, Training, and 
     Career Advancement To Address Health Professions Workforce 
     Needs.--
       ``(1) Authority to award grants.--The Secretary, in 
     consultation with the Secretary of Labor, shall award grants 
     to eligible entities to conduct demonstration projects that 
     are designed to provide eligible individuals with the 
     opportunity to obtain education and training for occupations 
     in the health care field that pay well and are expected to 
     either experience labor shortages or be in high demand.
       ``(2) Requirements.--
       ``(A) Aid and supportive services.--
       ``(i) In general.--A demonstration project conducted by an 
     eligible entity awarded a grant under this section shall, if 
     appropriate, provide eligible individuals participating in 
     the project with financial aid, child care, case management, 
     and other supportive services.
       ``(ii) Treatment.--Any aid, services, or incentives 
     provided to an eligible beneficiary participating in a 
     demonstration project under this section shall not be 
     considered income, and shall not be taken into account for 
     purposes of determining the individual's eligibility for, or 
     amount of, benefits under any means-tested program.
       ``(B) Consultation and coordination.--An eligible entity 
     applying for a grant to carry out a demonstration project 
     under this section shall demonstrate in the application that 
     the entity has consulted with the State agency responsible 
     for administering the State TANF program, the local workforce 
     investment board in the area in which the project is to be 
     conducted (unless the applicant is such board), the State 
     workforce investment board established under section 111 of 
     the Workforce Investment Act of 1998, and the State 
     Apprenticeship Agency recognized under the Act of August 16, 
     1937 (commonly known as the `National Apprenticeship Act') 
     (or if no agency has been recognized in the State, the Office 
     of Apprenticeship of the Department of Labor) and that the 
     project will be carried out in coordination with such 
     entities.
       ``(C) Assurance of opportunities for indian populations.--
     The Secretary shall award at least 3 grants under this 
     subsection to an eligible entity that is an Indian tribe, 
     tribal organization, or Tribal College or University.
       ``(3) Reports and evaluation.--
       ``(A) Eligible entities.--An eligible entity awarded a 
     grant to conduct a demonstration project under this 
     subsection shall submit interim reports to the Secretary on 
     the activities carried out under the project and a final 
     report on such activities upon the conclusion of the 
     entities' participation in the project. Such reports shall 
     include assessments of the effectiveness of such activities 
     with respect to improving outcomes for the eligible 
     individuals participating in the project and with respect to 
     addressing health professions workforce needs in the areas in 
     which the project is conducted.
       ``(B) Evaluation.--The Secretary shall, by grant, contract, 
     or interagency agreement, evaluate the demonstration projects 
     conducted under this subsection. Such evaluation shall 
     include identification of successful activities for creating 
     opportunities for developing and sustaining, particularly 
     with respect to low-income individuals and other entry-level 
     workers, a health professions workforce that has accessible 
     entry points, that meets high standards for education, 
     training, certification, and professional development, and 
     that provides increased wages and affordable benefits, 
     including health care coverage, that are responsive to the 
     workforce's needs.
       ``(C) Report to congress.--The Secretary shall submit 
     interim reports and, based on the evaluation conducted under 
     subparagraph (B), a final report to Congress on the 
     demonstration projects conducted under this subsection.
       ``(4) Definitions.--In this subsection:
       ``(A) Eligible entity.--The term `eligible entity' means a 
     State, an Indian tribe or tribal organization, an institution 
     of higher education, a local workforce investment board 
     established under section 117 of the Workforce Investment Act 
     of 1998, a sponsor of an apprenticeship program registered 
     under the National Apprenticeship Act or a community-based 
     organization.
       ``(B) Eligible individual.--
       ``(i) In general.--The term `eligible individual' means a 
     individual receiving assistance under the State TANF program.
       ``(ii) Other low-income individuals.--Such term may include 
     other low-income individuals described by the eligible entity 
     in its application for a grant under this section.
       ``(C) Indian tribe; tribal organization.--The terms `Indian 
     tribe' and `tribal organization' have the meaning given such 
     terms in section 4 of the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450b).
       ``(D) Institution of higher education.--The term 
     `institution of higher education' has the meaning given that 
     term in section 101 of the Higher Education Act of 1965 (20 
     U.S.C. 1001).
       ``(E) State.--The term `State' means each of the 50 States, 
     the District of Columbia, the Commonwealth of Puerto Rico, 
     the United States Virgin Islands, Guam, and American Samoa.
       ``(F) State tanf program.--The term `State TANF program' 
     means the temporary assistance for needy families program 
     funded under part A of title IV.
       ``(G) Tribal college or university.--The term `Tribal 
     College or University' has the meaning given that term in 
     section 316(b) of the Higher Education Act of 1965 (20 U.S.C. 
     1059c(b)).
       ``(b) Demonstration Project To Develop Training and 
     Certification Programs for Personal or Home Care Aides.--
       ``(1) Authority to award grants.--Not later than 18 months 
     after the date of enactment of this section, the Secretary 
     shall award grants to eligible entities that are States to 
     conduct demonstration projects for purposes of developing 
     core training competencies and certification programs for 
     personal or home care aides. The Secretary shall--
       ``(A) evaluate the efficacy of the core training 
     competencies described in paragraph (3)(A) for newly hired 
     personal or home care aides and the methods used by States to 
     implement such core training competencies in accordance with 
     the issues specified in paragraph (3)(B); and
       ``(B) ensure that the number of hours of training provided 
     by States under the demonstration project with respect to 
     such core training competencies are not less than the number 
     of hours of training required under any applicable State or 
     Federal law or regulation.
       ``(2) Duration.--A demonstration project shall be conducted 
     under this subsection for not less than 3 years.
       ``(3) Core training competencies for personal or home care 
     aides.--
       ``(A) In general.--The core training competencies for 
     personal or home care aides described in this subparagraph 
     include competencies with respect to the following areas:
       ``(i) The role of the personal or home care aide (including 
     differences between a personal or home care aide employed by 
     an agency and a personal or home care aide employed directly 
     by the health care consumer or an independent provider).
       ``(ii) Consumer rights, ethics, and confidentiality 
     (including the role of proxy decision-makers in the case 
     where a health care consumer has impaired decision-making 
     capacity).
       ``(iii) Communication, cultural and linguistic competence 
     and sensitivity, problem solving, behavior management, and 
     relationship skills.
       ``(iv) Personal care skills.
       ``(v) Health care support.
       ``(vi) Nutritional support.
       ``(vii) Infection control.
       ``(viii) Safety and emergency training.
       ``(ix) Training specific to an individual consumer's needs 
     (including older individuals, younger individuals with 
     disabilities, individuals with developmental disabilities, 
     individuals with dementia, and individuals with mental and 
     behavioral health needs).
       ``(x) Self-Care.
       ``(B) Implementation.--The implementation issues specified 
     in this subparagraph include the following:
       ``(i) The length of the training.
       ``(ii) The appropriate trainer to student ratio.
       ``(iii) The amount of instruction time spent in the 
     classroom as compared to on-site in the home or a facility.
       ``(iv) Trainer qualifications.
       ``(v) Content for a `hands-on' and written certification 
     exam.

[[Page S12223]]

       ``(vi) Continuing education requirements.
       ``(4) Application and selection criteria.--
       ``(A) In general.--
       ``(i) Number of states.--The Secretary shall enter into 
     agreements with not more than 6 States to conduct 
     demonstration projects under this subsection.
       ``(ii) Requirements for states.--An agreement entered into 
     under clause (i) shall require that a participating State--

       ``(I) implement the core training competencies described in 
     paragraph (3)(A); and
       ``(II) develop written materials and protocols for such 
     core training competencies, including the development of a 
     certification test for personal or home care aides who have 
     completed such training competencies.

       ``(iii) Consultation and collaboration with community and 
     vocational colleges.--The Secretary shall encourage 
     participating States to consult with community and vocational 
     colleges regarding the development of curricula to implement 
     the project with respect to activities, as applicable, which 
     may include consideration of such colleges as partners in 
     such implementation.
       ``(B) Application and eligibility.--A State seeking to 
     participate in the project shall--
       ``(i) submit an application to the Secretary containing 
     such information and at such time as the Secretary may 
     specify;
       ``(ii) meet the selection criteria established under 
     subparagraph (C); and
       ``(iii) meet such additional criteria as the Secretary may 
     specify.
       ``(C) Selection criteria.--In selecting States to 
     participate in the program, the Secretary shall establish 
     criteria to ensure (if applicable with respect to the 
     activities involved)--
       ``(i) geographic and demographic diversity;
       ``(ii) that the existing training standards for personal or 
     home care aides in each participating State--

       ``(I) are different from such standards in the other 
     participating States; and
       ``(II) are different from the core training competencies 
     described in paragraph (3)(A);

       ``(iii) that participating States do not reduce the number 
     of hours of training required under applicable State law or 
     regulation after being selected to participate in the 
     project; and
       ``(iv) that participating States recruit a minimum number 
     of eligible health and long-term care providers to 
     participate in the project.
       ``(D) Technical assistance.--The Secretary shall provide 
     technical assistance to States in developing written 
     materials and protocols for such core training competencies.
       ``(5) Evaluation and report.--
       ``(A) Evaluation.--The Secretary shall develop an 
     experimental or control group testing protocol in 
     consultation with an independent evaluation contractor 
     selected by the Secretary. Such contractor shall evaluate--
       ``(i) the impact of core training competencies described in 
     paragraph (3)(A), including curricula developed to implement 
     such core training competencies, for personal or home care 
     aides within each participating State on job satisfaction, 
     mastery of job skills, beneficiary and family caregiver 
     satisfaction with services, and additional measures 
     determined by the Secretary in consultation with the expert 
     panel;
       ``(ii) the impact of providing such core training 
     competencies on the existing training infrastructure and 
     resources of States; and
       ``(iii) whether a minimum number of hours of initial 
     training should be required for personal or home care aides 
     and, if so, what minimum number of hours should be required.
       ``(B) Reports.--
       ``(i) Report on initial implementation.--Not later than 2 
     years after the date of enactment of this section, the 
     Secretary shall submit to Congress a report on the initial 
     implementation of activities conducted under the 
     demonstration project, including any available results of the 
     evaluation conducted under subparagraph (A) with respect to 
     such activities, together with such recommendations for 
     legislation or administrative action as the Secretary 
     determines appropriate.
       ``(ii) Final report.--Not later than 1 year after the 
     completion of the demonstration project, the Secretary shall 
     submit to Congress a report containing the results of the 
     evaluation conducted under subparagraph (A), together with 
     such recommendations for legislation or administrative action 
     as the Secretary determines appropriate.
       ``(6) Definitions.--In this subsection:
       ``(A) Eligible health and long-term care provider.--The 
     term `eligible health and long-term care provider' means a 
     personal or home care agency (including personal or home care 
     public authorities), a nursing home, a home health agency (as 
     defined in section 1861(o)), or any other health care 
     provider the Secretary determines appropriate which--
       ``(i) is licensed or authorized to provide services in a 
     participating State; and
       ``(ii) receives payment for services under a State health 
     security program.
       ``(B) Personal or home care aide.--The term `personal or 
     home care aide' means an individual who helps individuals who 
     are elderly, disabled, ill, or mentally disabled (including 
     an individual with Alzheimer's disease or other dementia) to 
     live in their own home or a residential care facility (such 
     as a nursing home, assisted living facility, or any other 
     facility the Secretary determines appropriate) by providing 
     routine personal care services and other appropriate services 
     to the individual.
       ``(C) State.--The term `State' has the meaning given that 
     term for purposes of title XIX.
       ``(c) Funding.--
       ``(1) In general.--Subject to paragraph (2), out of any 
     funds in the Treasury not otherwise appropriated, there are 
     appropriated to the Secretary to carry out subsections (a) 
     and (b), $85,000,000 for each of fiscal years 2010 through 
     2014.
       ``(2) Training and certification programs for personal and 
     home care aides.--With respect to the demonstration projects 
     under subsection (b), the Secretary shall use $5,000,000 of 
     the amount appropriated under paragraph (1) for each of 
     fiscal years 2010 through 2012 to carry out such projects. No 
     funds appropriated under paragraph (1) shall be used to carry 
     out demonstration projects under subsection (b) after fiscal 
     year 2012.
       ``(d) Nonapplication.--
       ``(1) In general.--Except as provided in paragraph (2), the 
     preceding sections of this title shall not apply to grant 
     awarded under this section.
       ``(2) Limitations on use of grants.--Section 2005(a) (other 
     than paragraph (6)) shall apply to a grant awarded under this 
     section to the same extent and in the same manner as such 
     section applies to payments to States under this title.''.
       (b) Extension of Family-To-Family Health Information 
     Centers.--Section 501(c)(1)(A)(iii) of the Social Security 
     Act (42 U.S.C. 701(c)(1)(A)(iii)) is amended by striking 
     ``fiscal year 2009'' and inserting ``each of fiscal years 
     2009 through 2012''.

     SEC. 4502. INCREASING TEACHING CAPACITY.

       (a) Teaching Health Centers Training and Enhancement.--Part 
     C of title VII of the Public Health Service Act (42 U.S.C. 
     293k et. seq.), as amended by section 4303, is further 
     amended by inserting after section 749 the following:

     ``SEC. 749A. TEACHING HEALTH CENTERS DEVELOPMENT GRANTS.

       ``(a) Program Authorized.--The Secretary may award grants 
     under this section to teaching health centers for the purpose 
     of establishing new accredited or expanded primary care 
     residency programs.
       ``(b) Amount and Duration.--Grants awarded under this 
     section shall be for a term of not more than 3 years and the 
     maximum award may not be more than $500,000.
       ``(c) Use of Funds.--Amounts provided under a grant under 
     this section shall be used to cover the costs of--
       ``(1) establishing or expanding a primary care residency 
     training program described in subsection (a), including costs 
     associated with--
       ``(A) curriculum development;
       ``(B) recruitment, training and retention of residents and 
     faculty:
       ``(C) accreditation by the Accreditation Council for 
     Graduate Medical Education (ACGME), the American Dental 
     Association (ADA), or the American Osteopathic Association 
     (AOA); and
       ``(D) faculty salaries during the development phase; and
       ``(2) technical assistance provided by an eligible entity.
       ``(d) Application.--A teaching health center seeking a 
     grant under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(e) Preference for Certain Applications.--In selecting 
     recipients for grants under this section, the Secretary shall 
     give preference to any such application that documents an 
     existing affiliation agreement with an area health education 
     center program as defined in sections 751 and 799B.
       ``(f) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means an 
     organization capable of providing technical assistance 
     including an area health education center program as defined 
     in sections 751 and 799B.
       ``(2) Primary care residency program.--The term `primary 
     care residency program' means an approved graduate medical 
     residency training program (as defined in section 340H) in 
     family medicine, internal medicine, pediatrics, internal 
     medicine-pediatrics, obstetrics and gynecology, psychiatry, 
     general dentistry, pediatric dentistry, and geriatrics.
       ``(3) Teaching health center.--
       ``(A) In general.--The term `teaching health center' means 
     an entity that--
       ``(i) is a community based, ambulatory patient care center; 
     and
       ``(ii) operates a primary care residency program.
       ``(B) Inclusion of certain entities.--Such term includes 
     the following:
       ``(i) A Federally qualified health center (as defined in 
     section 1905(l)(2)(B), of the Social Security Act).
       ``(ii) A community mental health center (as defined in 
     section 1861(ff)(3)(B) of the Social Security Act).
       ``(iii) A rural health clinic, as defined in section 
     1861(aa) of the Social Security Act.
       ``(iv) A health center operated by the Indian Health 
     Service, an Indian tribe or tribal organization, or an urban 
     Indian organization (as defined in section 4 of the Indian 
     Health Care Improvement Act).
       ``(v) An entity receiving funds under title X of the Public 
     Health Service Act.

[[Page S12224]]

       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated, $25,000,000 for fiscal year 2010, 
     $50,000,000 for fiscal year 2011, $50,000,000 for fiscal year 
     2012, and such sums as may be necessary for each fiscal year 
     thereafter to carry out this section. Not to exceed 
     $5,000,000 annually may be used for technical assistance 
     program grants.''.
       (b) National Health Service Corps Teaching Capacity.--
     Section 338C(a) of the Public Health Service Act (42 U.S.C. 
     254m(a)) is amended to read as follows:
       ``(a) Service in Full-Time Clinical Practice.--Except as 
     provided in section 338D, each individual who has entered 
     into a written contract with the Secretary under section 338A 
     or 338B shall provide service in the full-time clinical 
     practice of such individual's profession as a member of the 
     Corps for the period of obligated service provided in such 
     contract. For the purpose of calculating time spent in full-
     time clinical practice under this subsection, up to 50 
     percent of time spent teaching by a member of the Corps may 
     be counted toward his or her service obligation.''.
       (c) Payments to Qualified Teaching Health Centers.--Part D 
     of title III of the Public Health Service Act (42 U.S.C. 254b 
     et seq.) is amended by adding at the end the following:

   ``Subpart XX--Support of Graduate Medical Education in Qualified 
                        Teaching Health Centers

     ``SEC. 340A. PROGRAM OF PAYMENTS TO TEACHING HEALTH CENTERS 
                   THAT OPERATE GRADUATE MEDICAL EDUCATION 
                   PROGRAMS.

       ``(a) Payments.--Subject to subsection (h)(2), the 
     Secretary shall make payments under this section for direct 
     expenses and for indirect expenses to qualified teaching 
     health centers that are listed as sponsoring institutions by 
     the relevant accrediting body for expansion of existing or 
     establishment of new approved graduate medical residency 
     training programs.
       ``(b) Amount of Payments.--
       ``(1) In general.--Subject to paragraph (2), the amounts 
     payable under this section to qualified teaching health 
     centers for an approved graduate medical residency training 
     program for a fiscal year are each of the following amounts:
       ``(A) Direct expense amount.--The amount determined under 
     subsection (c) for direct expenses associated with sponsoring 
     approved graduate medical residency training programs.
       ``(B) Indirect expense amount.--The amount determined under 
     subsection (d) for indirect expenses associated with the 
     additional costs relating to teaching residents in such 
     programs.
       ``(2) Capped amount.--
       ``(A) In general.--The total of the payments made to 
     qualified teaching health centers under paragraph (1)(A) or 
     paragraph (1)(B) in a fiscal year shall not exceed the amount 
     of funds appropriated under subsection (g) for such payments 
     for that fiscal year.
       ``(B) Limitation.--The Secretary shall limit the funding of 
     full-time equivalent residents in order to ensure the direct 
     and indirect payments as determined under subsection (c) and 
     (d) do not exceed the total amount of funds appropriated in a 
     fiscal year under subsection (g).
       ``(c) Amount of Payment for Direct Graduate Medical 
     Education.--
       ``(1) In general.--The amount determined under this 
     subsection for payments to qualified teaching health centers 
     for direct graduate expenses relating to approved graduate 
     medical residency training programs for a fiscal year is 
     equal to the product of--
       ``(A) the updated national per resident amount for direct 
     graduate medical education, as determined under paragraph 
     (2); and
       ``(B) the average number of full-time equivalent residents 
     in the teaching health center's graduate approved medical 
     residency training programs as determined under section 
     1886(h)(4) of the Social Security Act (without regard to the 
     limitation under subparagraph (F) of such section) during the 
     fiscal year.
       ``(2) Updated national per resident amount for direct 
     graduate medical education.--The updated per resident amount 
     for direct graduate medical education for a qualified 
     teaching health center for a fiscal year is an amount 
     determined as follows:
       ``(A) Determination of qualified teaching health center per 
     resident amount.--The Secretary shall compute for each 
     individual qualified teaching health center a per resident 
     amount--
       ``(i) by dividing the national average per resident amount 
     computed under section 340E(c)(2)(D) into a wage-related 
     portion and a non-wage related portion by applying the 
     proportion determined under subparagraph (B);
       ``(ii) by multiplying the wage-related portion by the 
     factor applied under section 1886(d)(3)(E) of the Social 
     Security Act (but without application of section 4410 of the 
     Balanced Budget Act of 1997 (42 U.S.C. 1395ww note)) during 
     the preceding fiscal year for the teaching health center's 
     area; and
       ``(iii) by adding the non-wage-related portion to the 
     amount computed under clause (ii).
       ``(B) Updating rate.--The Secretary shall update such per 
     resident amount for each such qualified teaching health 
     center as determined appropriate by the Secretary.
       ``(d) Amount of Payment for Indirect Medical Education.--
       ``(1) In general.--The amount determined under this 
     subsection for payments to qualified teaching health centers 
     for indirect expenses associated with the additional costs of 
     teaching residents for a fiscal year is equal to an amount 
     determined appropriate by the Secretary.
       ``(2) Factors.--In determining the amount under paragraph 
     (1), the Secretary shall--
       ``(A) evaluate indirect training costs relative to 
     supporting a primary care residency program in qualified 
     teaching health centers; and
       ``(B) based on this evaluation, assure that the aggregate 
     of the payments for indirect expenses under this section and 
     the payments for direct graduate medical education as 
     determined under subsection (c) in a fiscal year do not 
     exceed the amount appropriated for such expenses as 
     determined in subsection (g).
       ``(3) Interim payment.--Before the Secretary makes a 
     payment under this subsection pursuant to a determination of 
     indirect expenses under paragraph (1), the Secretary may 
     provide to qualified teaching health centers a payment, in 
     addition to any payment made under subsection (c), for 
     expected indirect expenses associated with the additional 
     costs of teaching residents for a fiscal year, based on an 
     estimate by the Secretary.
       ``(e) Clarification Regarding Relationship to Other 
     Payments for Graduate Medical Education.--Payments under this 
     section--
       ``(1) shall be in addition to any payments--
       ``(A) for the indirect costs of medical education under 
     section 1886(d)(5)(B) of the Social Security Act;
       ``(B) for direct graduate medical education costs under 
     section 1886(h) of such Act; and
       ``(C) for direct costs of medical education under section 
     1886(k) of such Act;
       ``(2) shall not be taken into account in applying the 
     limitation on the number of total full-time equivalent 
     residents under subparagraphs (F) and (G) of section 
     1886(h)(4) of such Act and clauses (v), (vi)(I), and (vi)(II) 
     of section 1886(d)(5)(B) of such Act for the portion of time 
     that a resident rotates to a hospital; and
       ``(3) shall not include the time in which a resident is 
     counted toward full-time equivalency by a hospital under 
     paragraph (2) or under section 1886(d)(5)(B)(iv) of the 
     Social Security Act, section 1886(h)(4)(E) of such Act, or 
     section 340E of this Act.
       ``(f) Reconciliation.--The Secretary shall determine any 
     changes to the number of residents reported by a hospital in 
     the application of the hospital for the current fiscal year 
     to determine the final amount payable to the hospital for the 
     current fiscal year for both direct expense and indirect 
     expense amounts. Based on such determination, the Secretary 
     shall recoup any overpayments made to pay any balance due to 
     the extent possible. The final amount so determined shall be 
     considered a final intermediary determination for the 
     purposes of section 1878 of the Social Security Act and shall 
     be subject to administrative and judicial review under that 
     section in the same manner as the amount of payment under 
     section 1186(d) of such Act is subject to review under such 
     section.
       ``(g) Funding.--To carry out this section, there are 
     appropriated such sums as may be necessary, not to exceed 
     $230,000,000, for the period of fiscal years 2011 through 
     2015.
       ``(h) Annual Reporting Required.--
       ``(1) Annual report.--The report required under this 
     paragraph for a qualified teaching health center for a fiscal 
     year is a report that includes (in a form and manner 
     specified by the Secretary) the following information for the 
     residency academic year completed immediately prior to such 
     fiscal year:
       ``(A) The types of primary care resident approved training 
     programs that the qualified teaching health center provided 
     for residents.
       ``(B) The number of approved training positions for 
     residents described in paragraph (4).
       ``(C) The number of residents described in paragraph (4) 
     who completed their residency training at the end of such 
     residency academic year and care for vulnerable populations 
     living in underserved areas.
       ``(D) Other information as deemed appropriate by the 
     Secretary.
       ``(2) Audit authority; limitation on payment.--
       ``(A) Audit authority.--The Secretary may audit a qualified 
     teaching health center to ensure the accuracy and 
     completeness of the information submitted in a report under 
     paragraph (1).
       ``(B) Limitation on payment.--A teaching health center may 
     only receive payment in a cost reporting period for a number 
     of such resident positions that is greater than the base 
     level of primary care resident positions, as determined by 
     the Secretary. For purposes of this subparagraph, the `base 
     level of primary care residents' for a teaching health center 
     is the level of such residents as of a base period.
       ``(3) Reduction in payment for failure to report.--
       ``(A) In general.--The amount payable under this section to 
     a qualified teaching health center for a fiscal year shall be 
     reduced by at least 25 percent if the Secretary determines 
     that--
       ``(i) the qualified teaching health center has failed to 
     provide the Secretary, as an addendum to the qualified 
     teaching health center's application under this section for 
     such

[[Page S12225]]

     fiscal year, the report required under paragraph (1) for the 
     previous fiscal year; or
       ``(ii) such report fails to provide complete and accurate 
     information required under any subparagraph of such 
     paragraph.
       ``(B) Notice and opportunity to provide accurate and 
     missing information.--Before imposing a reduction under 
     subparagraph (A) on the basis of a qualified teaching health 
     center's failure to provide complete and accurate information 
     described in subparagraph (A)(ii), the Secretary shall 
     provide notice to the teaching health center of such failure 
     and the Secretary's intention to impose such reduction and 
     shall provide the teaching health center with the opportunity 
     to provide the required information within the period of 30 
     days beginning on the date of such notice. If the teaching 
     health center provides such information within such period, 
     no reduction shall be made under subparagraph (A) on the 
     basis of the previous failure to provide such information.
       ``(4) Residents.--The residents described in this paragraph 
     are those who are in part-time or full-time equivalent 
     resident training positions at a qualified teaching health 
     center in any approved graduate medical residency training 
     program.
       ``(i) Regulations.--The Secretary shall promulgate 
     regulations to carry out this section.
       ``(j) Definitions.--In this section:
       ``(1) Approved graduate medical residency training 
     program.--The term `approved graduate medical residency 
     training program' means a residency or other postgraduate 
     medical training program--
       ``(A) participation in which may be counted toward 
     certification in a specialty or subspecialty and includes 
     formal postgraduate training programs in geriatric medicine 
     approved by the Secretary; and
       ``(B) that meets criteria for accreditation (as established 
     by the Accreditation Council for Graduate Medical Education, 
     the American Osteopathic Association, or the American Dental 
     Association).
       ``(2) Primary care residency program.--The term `primary 
     care residency program' has the meaning given that term in 
     section 749A.
       ``(3) Qualified teaching health center.--The term 
     `qualified teaching health center' has the meaning given the 
     term `teaching health center' in section 749A.''.

     SEC. 4503. GRADUATE NURSE EDUCATION DEMONSTRATION.

       (a) In General.--
       (1) Establishment.--
       (A) In general.--The Secretary shall establish a graduate 
     nurse education demonstration under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.) under which an eligible 
     hospital may receive payment for the hospital's reasonable 
     costs (described in paragraph (2)) for the provision of 
     qualified clinical training to advance practice nurses.
       (B) Number.--The demonstration shall include up to 5 
     eligible hospitals.
       (C) Written agreements.--Eligible hospitals selected to 
     participate in the demonstration shall enter into written 
     agreements pursuant to subsection (b) in order to reimburse 
     the eligible partners of the hospital the share of the costs 
     attributable to each partner.
       (2) Costs described.--
       (A) In general.--Subject to subparagraph (B) and subsection 
     (d), the costs described in this paragraph are the reasonable 
     costs (as described in section 1861(v) of the Social Security 
     Act (42 U.S.C. 1395x(v))) of each eligible hospital for the 
     clinical training costs (as determined by the Secretary) that 
     are attributable to providing advanced practice registered 
     nurses with qualified training.
       (B) Limitation.--With respect to a year, the amount 
     reimbursed under subparagraph (A) may not exceed the amount 
     of costs described in subparagraph (A) that are attributable 
     to an increase in the number of advanced practice registered 
     nurses enrolled in a program that provides qualified training 
     during the year and for which the hospital is being 
     reimbursed under the demonstration, as compared to the 
     average number of advanced practice registered nurses who 
     graduated in each year during the period beginning on January 
     1, 2006, and ending on December 31, 2010 (as determined by 
     the Secretary) from the graduate nursing education program 
     operated by the applicable school of nursing that is an 
     eligible partner of the hospital for purposes of the 
     demonstration.
       (3) Waiver authority.--The Secretary may waive such 
     requirements of titles XI and XVIII of the Social Security 
     Act as may be necessary to carry out the demonstration.
       (4) Administration.--Chapter 35 of title 44, United States 
     Code, shall not apply to the implementation of this section.
       (b) Written Agreements With Eligible Partners.--No payment 
     shall be made under this section to an eligible hospital 
     unless such hospital has in effect a written agreement with 
     the eligible partners of the hospital. Such written agreement 
     shall describe, at a minimum--
       (1) the obligations of the eligible partners with respect 
     to the provision of qualified training; and
       (2) the obligation of the eligible hospital to reimburse 
     such eligible partners applicable (in a timely manner) for 
     the costs of such qualified training attributable to partner.
       (c) Evaluation.--Not later than October 17, 2017, the 
     Secretary shall submit to Congress a report on the 
     demonstration. Such report shall include an analysis of the 
     following:
       (1) The growth in the number of advanced practice 
     registered nurses with respect to a specific base year as a 
     result of the demonstration.
       (2) The growth for each of the specialties described in 
     subparagraphs (A) through (D) of subsection (e)(1).
       (3) Other items the Secretary determines appropriate and 
     relevant.
       (d) Funding.--
       (1) In general.--There is hereby appropriated to the 
     Secretary, out of any funds in the Treasury not otherwise 
     appropriated, $50,000,000 for each of fiscal years 2012 
     through 2015 to carry out this section, including the design, 
     implementation, monitoring, and evaluation of the 
     demonstration.
       (2) Proration.--If the aggregate payments to eligible 
     hospitals under the demonstration exceed $50,000,000 for a 
     fiscal year described in paragraph (1), the Secretary shall 
     prorate the payment amounts to each eligible hospital in 
     order to ensure that the aggregate payments do not exceed 
     such amount.
       (3) Without fiscal year limitation.--Amounts appropriated 
     under this subsection shall remain available without fiscal 
     year limitation.
       (e) Definitions.--In this section:
       (1) Advanced practice registered nurse.--The term 
     ``advanced practice registered nurse'' includes the 
     following:
       (A) A clinical nurse specialist (as defined in subsection 
     (aa)(5) of section 1861 of the Social Security Act (42 U.S.C. 
     1395x)).
       (B) A nurse practitioner (as defined in such subsection).
       (C) A certified registered nurse anesthetist (as defined in 
     subsection (bb)(2) of such section).
       (D) A certified nurse-midwife (as defined in subsection 
     (gg)(2) of such section).
       (2) Applicable non-hospital community-based care setting.--
     The term ``applicable non-hospital community-based care 
     setting'' means a non-hospital community-based care setting 
     which has entered into a written agreement (as described in 
     subsection (b)) with the eligible hospital participating in 
     the demonstration. Such settings include Federally qualified 
     health centers, rural health clinics, and other non-hospital 
     settings as determined appropriate by the Secretary.
       (3) Applicable school of nursing.--The term ``applicable 
     school of nursing'' means an accredited school of nursing (as 
     defined in section 801 of the Public Health Service Act) 
     which has entered into a written agreement (as described in 
     subsection (b)) with the eligible hospital participating in 
     the demonstration.
       (4) Demonstration.--The term ``demonstration'' means the 
     graduate nurse education demonstration established under 
     subsection (a).
       (5) Eligible hospital.--The term ``eligible hospital'' 
     means a hospital (as defined in subsection (e) of section 
     1861 of the Social Security Act (42 U.S.C. 1395x)) or a 
     critical access hospital (as defined in subsection (mm)(1) of 
     such section) that has a written agreement in place with--
       (A) 1 or more applicable schools of nursing; and
       (B) 2 or more applicable non-hospital community-based care 
     settings.
       (6) Eligible partners.--The term ``eligible partners'' 
     includes the following:
       (A) An applicable non-hospital community-based care 
     setting.
       (B) An applicable school of nursing.
       (7) Qualified training.--
       (A) In general.--The term ``qualified training'' means 
     training--
       (i) that provides an advanced practice registered nurse 
     with the clinical skills necessary to provide primary care, 
     preventive care, transitional care, chronic care management, 
     and other services appropriate for individuals entitled to, 
     or enrolled for, benefits under part A of title XVIII of the 
     Social Security Act, or enrolled under part B of such title; 
     and
       (ii) subject to subparagraph (B), at least half of which is 
     provided in a non-hospital community-based care setting.
       (B) Waiver of requirement half of training be provided in 
     non-hospital community-based care setting in certain areas.--
     The Secretary may waive the requirement under subparagraph 
     (A)(ii) with respect to eligible hospitals located in rural 
     or medically underserved areas.
       (8) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

          Subtitle G--Improving Access to Health Care Services

     SEC. 4601. 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--

[[Page S12226]]

       ``(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, or a 
     sole community hospital (as defined for purposes of section 
     1886(d)(5)(D)(iii) 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. 4602. 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. 4603. 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. 4604. 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. AWARDS 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' 
     means adults with mental illnesses who have co-occurring 
     primary care conditions and chronic diseases.
       ``(b) Program Authorized.--The Secretary, acting through 
     the Administrator shall award grants and cooperative 
     agreements 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 or 
     cooperative agreement 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, including a description of 
     partnerships, 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, of on site primary care services;
       ``(B) reasonable costs associated with medically necessary 
     referrals to qualified specialty care professionals, other 
     coordinators of care or, if permitted by the terms of the 
     grant or cooperative agreement, 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 modifications needed to bring primary and 
     specialty care professionals on site at the eligible entity.
       ``(2) Limitation.--Not to exceed 15 percent of grant or 
     cooperative agreement funds may be used for activities 
     described in subparagraphs (C) and (D) of paragraph (1).
       ``(e) Evaluation.--Not later than 90 days 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.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $50,000,000 for fiscal year 2010 and such sums as may be 
     necessary for each of fiscal years 2011 through 2014.''.

     SEC. 4605. 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

[[Page S12227]]

     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.

                     Subtitle H--General Provisions

     SEC. 4701. 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.

[[Page S12228]]

              TITLE V--TRANSPARENCY AND PROGRAM INTEGRITY

         Subtitle A--Physician Ownership and Other Transparency

     SEC. 5001. TRANSPARENCY REPORTS AND REPORTING OF PHYSICIAN 
                   OWNERSHIP OR INVESTMENT INTERESTS.

       Part A of title XI of the Social Security Act (42 U.S.C. 
     1301 et seq.) is amended by inserting after section 1128F the 
     following new section:

     ``SEC. 1128G. TRANSPARENCY REPORTS AND REPORTING OF PHYSICIAN 
                   OWNERSHIP OR INVESTMENT INTERESTS.

       ``(a) Transparency Reports.--
       ``(1) Payments or other transfers of value.--
       ``(A) In general.--On March 31, 2013, and on the 90th day 
     of each calendar year beginning thereafter, any applicable 
     manufacturer that provides a payment or other transfer of 
     value to a covered recipient (or to an entity or individual 
     at the request of or designated on behalf of a covered 
     recipient), shall submit to the Secretary, in such electronic 
     form as the Secretary shall require, the following 
     information with respect to the preceding calendar year:
       ``(i) The name of the covered recipient.
       ``(ii) The business address of the covered recipient and, 
     in the case of a covered recipient who is a physician, the 
     specialty and National Provider Identifier of the covered 
     recipient.
       ``(iii) The amount of the payment or other transfer of 
     value.
       ``(iv) The dates on which the payment or other transfer of 
     value was provided to the covered recipient.
       ``(v) A description of the form of the payment or other 
     transfer of value, indicated (as appropriate for all that 
     apply) as--

       ``(I) cash or a cash equivalent;
       ``(II) in-kind items or services;
       ``(III) stock, a stock option, or any other ownership 
     interest, dividend, profit, or other return on investment; or
       ``(IV) any other form of payment or other transfer of value 
     (as defined by the Secretary).

       ``(vi) A description of the nature of the payment or other 
     transfer of value, indicated (as appropriate for all that 
     apply) as--

       ``(I) consulting fees;
       ``(II) compensation for services other than consulting;
       ``(III) honoraria;
       ``(IV) gift;
       ``(V) entertainment;
       ``(VI) food;
       ``(VII) travel (including the specified destinations);
       ``(VIII) education;
       ``(IX) research;
       ``(X) charitable contribution;
       ``(XI) royalty or license;
       ``(XII) current or prospective ownership or investment 
     interest;
       ``(XIII) direct compensation for serving as faculty or as a 
     speaker for a medical education program;
       ``(XIV) grant; or
       ``(XV) any other nature of the payment or other transfer of 
     value (as defined by the Secretary).

       ``(vii) If the payment or other transfer of value is 
     related to marketing, education, or research specific to a 
     covered drug, device, biological, or medical supply, the name 
     of that covered drug, device, biological, or medical supply.
       ``(viii) Any other categories of information regarding the 
     payment or other transfer of value the Secretary determines 
     appropriate.
       ``(B) Special rule for certain payments or other transfers 
     of value.--In the case where an applicable manufacturer 
     provides a payment or other transfer of value to an entity or 
     individual at the request of or designated on behalf of a 
     covered recipient, the applicable manufacturer shall disclose 
     that payment or other transfer of value under the name of the 
     covered recipient.
       ``(2) Physician ownership.--In addition to the requirement 
     under paragraph (1)(A), on March 31, 2013, and on the 90th 
     day of each calendar year beginning thereafter, any 
     applicable manufacturer or applicable group purchasing 
     organization shall submit to the Secretary, in such 
     electronic form as the Secretary shall require, the following 
     information regarding any ownership or investment interest 
     (other than an ownership or investment interest in a publicly 
     traded security and mutual fund, as described in section 
     1877(c)) held by a physician (or an immediate family member 
     of such physician (as defined for purposes of section 
     1877(a))) in the applicable manufacturer or applicable group 
     purchasing organization during the preceding year:
       ``(A) The dollar amount invested by each physician holding 
     such an ownership or investment interest.
       ``(B) The value and terms of each such ownership or 
     investment interest.
       ``(C) Any payment or other transfer of value provided to a 
     physician holding such an ownership or investment interest 
     (or to an entity or individual at the request of or 
     designated on behalf of a physician holding such an ownership 
     or investment interest), including the information described 
     in clauses (i) through (viii) of paragraph (1)(A), except 
     that in applying such clauses, `physician' shall be 
     substituted for `covered recipient' each place it appears.
       ``(D) Any other information regarding the ownership or 
     investment interest the Secretary determines appropriate.
       ``(b) Penalties for Noncompliance.--
       ``(1) Failure to report.--
       ``(A) In general.--Subject to subparagraph (B) except as 
     provided in paragraph (2), any applicable manufacturer or 
     applicable group purchasing organization that fails to submit 
     information required under subsection (a) in a timely manner 
     in accordance with rules or regulations promulgated to carry 
     out such subsection, shall be subject to a civil money 
     penalty of not less than $1,000, but not more than $10,000, 
     for each payment or other transfer of value or ownership or 
     investment interest not reported as required under such 
     subsection. Such penalty shall be imposed and collected in 
     the same manner as civil money penalties under subsection (a) 
     of section 1128A are imposed and collected under that 
     section.
       ``(B) Limitation.--The total amount of civil money 
     penalties imposed under subparagraph (A) with respect to each 
     annual submission of information under subsection (a) by an 
     applicable manufacturer or applicable group purchasing 
     organization shall not exceed $150,000.
       ``(2) Knowing failure to report.--
       ``(A) In general.--Subject to subparagraph (B), any 
     applicable manufacturer or applicable group purchasing 
     organization that knowingly fails to submit information 
     required under subsection (a) in a timely manner in 
     accordance with rules or regulations promulgated to carry out 
     such subsection, shall be subject to a civil money penalty of 
     not less than $10,000, but not more than $100,000, for each 
     payment or other transfer of value or ownership or investment 
     interest not reported as required under such subsection. Such 
     penalty shall be imposed and collected in the same manner as 
     civil money penalties under subsection (a) of section 1128A 
     are imposed and collected under that section.
       ``(B) Limitation.--The total amount of civil money 
     penalties imposed under subparagraph (A) with respect to each 
     annual submission of information under subsection (a) by an 
     applicable manufacturer or applicable group purchasing 
     organization shall not exceed $1,000,000.
       ``(3) Use of funds.--Funds collected by the Secretary as a 
     result of the imposition of a civil money penalty under this 
     subsection shall be used to carry out this section.
       ``(c) Procedures for Submission of Information and Public 
     Availability.--
       ``(1) In general.--
       ``(A) Establishment.--Not later than October 1, 2011, the 
     Secretary shall establish procedures--
       ``(i) for applicable manufacturers and applicable group 
     purchasing organizations to submit information to the 
     Secretary under subsection (a); and
       ``(ii) for the Secretary to make such information submitted 
     available to the public.
       ``(B) Definition of terms.--The procedures established 
     under subparagraph (A) shall provide for the definition of 
     terms (other than those terms defined in subsection (e)), as 
     appropriate, for purposes of this section.
       ``(C) Public availability.--Except as provided in 
     subparagraph (E), the procedures established under 
     subparagraph (A)(ii) shall ensure that, not later than 
     September 30, 2013, and on June 30 of each calendar year 
     beginning thereafter, the information submitted under 
     subsection (a) with respect to the preceding calendar year is 
     made available through an Internet website that--
       ``(i) is searchable and is in a format that is clear and 
     understandable;
       ``(ii) contains information that is presented by the name 
     of the applicable manufacturer or applicable group purchasing 
     organization, the name of the covered recipient, the business 
     address of the covered recipient, the specialty of the 
     covered recipient, the value of the payment or other transfer 
     of value, the date on which the payment or other transfer of 
     value was provided to the covered recipient, the form of the 
     payment or other transfer of value, indicated (as 
     appropriate) under subsection (a)(1)(A)(v), the nature of the 
     payment or other transfer of value, indicated (as 
     appropriate) under subsection (a)(1)(A)(vi), and the name of 
     the covered drug, device, biological, or medical supply, as 
     applicable;
       ``(iii) contains information that is able to be easily 
     aggregated and downloaded;
       ``(iv) contains a description of any enforcement actions 
     taken to carry out this section, including any penalties 
     imposed under subsection (b), during the preceding year;
       ``(v) contains background information on industry-physician 
     relationships;
       ``(vi) in the case of information submitted with respect to 
     a payment or other transfer of value described in 
     subparagraph (E)(i), lists such information separately from 
     the other information submitted under subsection (a) and 
     designates such separately listed information as funding for 
     clinical research;
       ``(vii) contains any other information the Secretary 
     determines would be helpful to the average consumer;
       ``(viii) does not contain the National Provider Identifier 
     of the covered recipient, and
       ``(ix) subject to subparagraph (D), provides the applicable 
     manufacturer, applicable group purchasing organization, or 
     covered recipient an opportunity to review and submit 
     corrections to the information submitted with respect to the 
     applicable manufacturer, applicable group purchasing 
     organization, or covered recipient, respectively, for a 
     period of not less than 45 days prior to such information 
     being made available to the public.

[[Page S12229]]

       ``(D) Clarification of time period for review and 
     corrections.--In no case may the 45-day period for review and 
     submission of corrections to information under subparagraph 
     (C)(ix) prevent such information from being made available to 
     the public in accordance with the dates described in the 
     matter preceding clause (i) in subparagraph (C).
       ``(E) Delayed publication for payments made pursuant to 
     product research or development agreements and clinical 
     investigations.--
       ``(i) In general.--In the case of information submitted 
     under subsection (a) with respect to a payment or other 
     transfer of value made to a covered recipient by an 
     applicable manufacturer pursuant to a product research or 
     development agreement for services furnished in connection 
     with research on a potential new medical technology or a new 
     application of an existing medical technology or the 
     development of a new drug, device, biological, or medical 
     supply, or by an applicable manufacturer in connection with a 
     clinical investigation regarding a new drug, device, 
     biological, or medical supply, the procedures established 
     under subparagraph (A)(ii) shall provide that such 
     information is made available to the public on the first date 
     described in the matter preceding clause (i) in subparagraph 
     (C) after the earlier of the following:

       ``(I) The date of the approval or clearance of the covered 
     drug, device, biological, or medical supply by the Food and 
     Drug Administration.
       ``(II) Four calendar years after the date such payment or 
     other transfer of value was made.

       ``(ii) Confidentiality of information prior to 
     publication.--Information described in clause (i) shall be 
     considered confidential and shall not be subject to 
     disclosure under section 552 of title 5, United States Code, 
     or any other similar Federal, State, or local law, until on 
     or after the date on which the information is made available 
     to the public under such clause.
       ``(2) Consultation.--In establishing the procedures under 
     paragraph (1), the Secretary shall consult with the Inspector 
     General of the Department of Health and Human Services, 
     affected industry, consumers, consumer advocates, and other 
     interested parties in order to ensure that the information 
     made available to the public under such paragraph is 
     presented in the appropriate overall context.
       ``(d) Annual Reports and Relation to State Laws.--
       ``(1) Annual report to congress.--Not later than April 1 of 
     each year beginning with 2013, the Secretary shall submit to 
     Congress a report that includes the following:
       ``(A) The information submitted under subsection (a) during 
     the preceding year, aggregated for each applicable 
     manufacturer and applicable group purchasing organization 
     that submitted such information during such year (except, in 
     the case of information submitted with respect to a payment 
     or other transfer of value described in subsection 
     (c)(1)(E)(i), such information shall be included in the first 
     report submitted to Congress after the date on which such 
     information is made available to the public under such 
     subsection).
       ``(B) A description of any enforcement actions taken to 
     carry out this section, including any penalties imposed under 
     subsection (b), during the preceding year.
       ``(2) Annual reports to states.--Not later than September 
     30, 2013 and on June 30 of each calendar year thereafter, the 
     Secretary shall submit to States a report that includes a 
     summary of the information submitted under subsection (a) 
     during the preceding year with respect to covered recipients 
     in the State (except, in the case of information submitted 
     with respect to a payment or other transfer of value 
     described in subsection (c)(1)(E)(i), such information shall 
     be included in the first report submitted to States after the 
     date on which such information is made available to the 
     public under such subsection).
       ``(3) Relation to state laws.--
       ``(A) In general.--In the case of a payment or other 
     transfer of value provided by an applicable manufacturer that 
     is received by a covered recipient (as defined in subsection 
     (e)) on or after January 1, 2012, subject to subparagraph 
     (B), the provisions of this section shall preempt any statute 
     or regulation of a State or of a political subdivision of a 
     State that requires an applicable manufacturer (as so 
     defined) to disclose or report, in any format, the type of 
     information (as described in subsection (a)) regarding such 
     payment or other transfer of value.
       ``(B) No preemption of additional requirements.--
     Subparagraph (A) shall not preempt any statute or regulation 
     of a State or of a political subdivision of a State that 
     requires the disclosure or reporting of information--
       ``(i) not of the type required to be disclosed or reported 
     under this section;
       ``(ii) described in subsection (e)(10)(B), except in the 
     case of information described in clause (i) of such 
     subsection;
       ``(iii) by any person or entity other than an applicable 
     manufacturer (as so defined) or a covered recipient (as 
     defined in subsection (e)); or
       ``(iv) to a Federal, State, or local governmental agency 
     for public health surveillance, investigation, or other 
     public health purposes or health oversight purposes.
       ``(C) Nothing in subparagraph (A) shall be construed to 
     limit the discovery or admissibility of information described 
     in such subparagraph in a criminal, civil, or administrative 
     proceeding.
       ``(4) Consultation.--The Secretary shall consult with the 
     Inspector General of the Department of Health and Human 
     Services on the implementation of this section.
       ``(e) Definitions.--In this section:
       ``(1) Applicable group purchasing organization.--The term 
     `applicable group purchasing organization' means a group 
     purchasing organization (as defined by the Secretary) that 
     purchases, arranges for, or negotiates the purchase of a 
     covered drug, device, biological, or medical supply which is 
     operating in the United States, or in a territory, 
     possession, or commonwealth of the United States.
       ``(2) Applicable manufacturer.--The term `applicable 
     manufacturer' means a manufacturer of a covered drug, device, 
     biological, or medical supply which is operating in the 
     United States, or in a territory, possession, or commonwealth 
     of the United States.
       ``(3) Clinical investigation.--The term `clinical 
     investigation' means any experiment involving 1 or more human 
     subjects, or materials derived from human subjects, in which 
     a drug or device is administered, dispensed, or used.
       ``(4) Covered device.--The term `covered device' means any 
     device for which payment is available under a State health 
     security program.
       ``(5) Covered drug, device, biological, or medical 
     supply.--The term `covered drug, device, biological, or 
     medical supply' means any drug, biological product, device, 
     or medical supply for which payment is available under a 
     State health security program.
       ``(6) Covered recipient.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     the term `covered recipient' means the following:
       ``(i) A physician.
       ``(ii) A teaching hospital.
       ``(B) Exclusion.--Such term does not include a physician 
     who is an employee of the applicable manufacturer that is 
     required to submit information under subsection (a).
       ``(7) Employee.--The term `employee' has the meaning given 
     such term in section 1877(h)(2).
       ``(8) Knowingly.--The term `knowingly' has the meaning 
     given such term in section 3729(b) of title 31, United States 
     Code.
       ``(9) Manufacturer of a covered drug, device, biological, 
     or medical supply.--The term `manufacturer of a covered drug, 
     device, biological, or medical supply' means any entity which 
     is engaged in the production, preparation, propagation, 
     compounding, or conversion of a covered drug, device, 
     biological, or medical supply (or any entity under common 
     ownership with such entity which provides assistance or 
     support to such entity with respect to the production, 
     preparation, propagation, compounding, conversion, marketing, 
     promotion, sale, or distribution of a covered drug, device, 
     biological, or medical supply).
       ``(10) Payment or other transfer of value.--
       ``(A) In general.--The term `payment or other transfer of 
     value' means a transfer of anything of value. Such term does 
     not include a transfer of anything of value that is made 
     indirectly to a covered recipient through a third party in 
     connection with an activity or service in the case where the 
     applicable manufacturer is unaware of the identity of the 
     covered recipient.
       ``(B) Exclusions.--An applicable manufacturer shall not be 
     required to submit information under subsection (a) with 
     respect to the following:
       ``(i) A transfer of anything the value of which is less 
     than $10, unless the aggregate amount transferred to, 
     requested by, or designated on behalf of the covered 
     recipient by the applicable manufacturer during the calendar 
     year exceeds $100. For calendar years after 2012, the dollar 
     amounts specified in the preceding sentence shall be 
     increased by the same percentage as the percentage increase 
     in the consumer price index for all urban consumers (all 
     items; U.S. city average) for the 12-month period ending with 
     June of the previous year.
       ``(ii) Product samples that are not intended to be sold and 
     are intended for patient use.
       ``(iii) Educational materials that directly benefit 
     patients or are intended for patient use.
       ``(iv) The loan of a covered device for a short-term trial 
     period, not to exceed 90 days, to permit evaluation of the 
     covered device by the covered recipient.
       ``(v) Items or services provided under a contractual 
     warranty, including the replacement of a covered device, 
     where the terms of the warranty are set forth in the purchase 
     or lease agreement for the covered device.
       ``(vi) A transfer of anything of value to a covered 
     recipient when the covered recipient is a patient and not 
     acting in the professional capacity of a covered recipient.
       ``(vii) Discounts (including rebates).
       ``(viii) In-kind items used for the provision of charity 
     care.
       ``(ix) A dividend or other profit distribution from, or 
     ownership or investment interest in, a publicly traded 
     security and mutual fund (as described in section 1877(c)).
       ``(x) In the case of an applicable manufacturer who offers 
     a self-insured plan, payments for the provision of health 
     care to employees under the plan.
       ``(xi) In the case of a covered recipient who is a licensed 
     non-medical professional, a transfer of anything of value to 
     the covered recipient if the transfer is payment solely for

[[Page S12230]]

     the non-medical professional services of such licensed non-
     medical professional.
       ``(xii) In the case of a covered recipient who is a 
     physician, a transfer of anything of value to the covered 
     recipient if the transfer is payment solely for the services 
     of the covered recipient with respect to a civil or criminal 
     action or an administrative proceeding.
       ``(11) Physician.--The term `physician' has the meaning 
     given that term in section 1861(r).''.

     SEC. 5002. PRESCRIPTION DRUG SAMPLE TRANSPARENCY.

       Part A of title XI of the Social Security Act (42 U.S.C. 
     1301 et seq.), as amended by section 5001, is amended by 
     inserting after section 1128G the following new section:

     ``SEC. 1128H. REPORTING OF INFORMATION RELATING TO DRUG 
                   SAMPLES.

       ``(a) In General.--Not later than April 1 of each year 
     (beginning with 2012), each manufacturer and authorized 
     distributor of record of an applicable drug shall submit to 
     the Secretary (in a form and manner specified by the 
     Secretary) the following information with respect to the 
     preceding year:
       ``(1) In the case of a manufacturer or authorized 
     distributor of record which makes distributions by mail or 
     common carrier under subsection (d)(2) of section 503 of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 353), the 
     identity and quantity of drug samples requested and the 
     identity and quantity of drug samples distributed under such 
     subsection during that year, aggregated by--
       ``(A) the name, address, professional designation, and 
     signature of the practitioner making the request under 
     subparagraph (A)(i) of such subsection, or of any individual 
     who makes or signs for the request on behalf of the 
     practitioner; and
       ``(B) any other category of information determined 
     appropriate by the Secretary.
       ``(2) In the case of a manufacturer or authorized 
     distributor of record which makes distributions by means 
     other than mail or common carrier under subsection (d)(3) of 
     such section 503, the identity and quantity of drug samples 
     requested and the identity and quantity of drug samples 
     distributed under such subsection during that year, 
     aggregated by--
       ``(A) the name, address, professional designation, and 
     signature of the practitioner making the request under 
     subparagraph (A)(i) of such subsection, or of any individual 
     who makes or signs for the request on behalf of the 
     practitioner; and
       ``(B) any other category of information determined 
     appropriate by the Secretary.
       ``(b) Definitions.--In this section:
       ``(1) Applicable drug.--The term `applicable drug' means a 
     drug--
       ``(A) which is subject to subsection (b) of such section 
     503; and
       ``(B) for which payment is available under a State health 
     security program.
       ``(2) Authorized distributor of record.--The term 
     `authorized distributor of record' has the meaning given that 
     term in subsection (e)(3)(A) of such section.
       ``(3) Manufacturer.--The term `manufacturer' has the 
     meaning given that term for purposes of subsection (d) of 
     such section.''.

         Subtitle B--Nursing Home Transparency and Improvement

             PART I--IMPROVING TRANSPARENCY OF INFORMATION

     SEC. 5101. REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL 
                   DISCLOSABLE PARTIES INFORMATION.

       (a) In General.--Section 1124 of the Social Security Act 
     (42 U.S.C. 1320a-3) is amended by adding at the end the 
     following new subsection:
       ``(c) Required Disclosure of Ownership and Additional 
     Disclosable Parties Information.--
       ``(1) Disclosure.--A facility shall have the information 
     described in paragraph (2) available--
       ``(A) during the period beginning on the date of the 
     enactment of this subsection and ending on the date such 
     information is made available to the public under section 
     5101(b) of the Patient Protection and Affordable Care Act for 
     submission to the Secretary, the Inspector General of the 
     Department of Health and Human Services, the State in which 
     the facility is located, and the State long-term care 
     ombudsman in the case where the Secretary, the Inspector 
     General, the State, or the State long-term care ombudsman 
     requests such information; and
       ``(B) beginning on the effective date of the final 
     regulations promulgated under paragraph (3)(A), for reporting 
     such information in accordance with such final regulations.
     Nothing in subparagraph (A) shall be construed as authorizing 
     a facility to dispose of or delete information described in 
     such subparagraph after the effective date of the final 
     regulations promulgated under paragraph (3)(A).
       ``(2) Information described.--
       ``(A) In general.--The following information is described 
     in this paragraph:
       ``(i) The information described in subsections (a) and (b), 
     subject to subparagraph (C).
       ``(ii) The identity of and information on--

       ``(I) each member of the governing body of the facility, 
     including the name, title, and period of service of each such 
     member;
       ``(II) each person or entity who is an officer, director, 
     member, partner, trustee, or managing employee of the 
     facility, including the name, title, and period of service of 
     each such person or entity; and
       ``(III) each person or entity who is an additional 
     disclosable party of the facility.

       ``(iii) The organizational structure of each additional 
     disclosable party of the facility and a description of the 
     relationship of each such additional disclosable party to the 
     facility and to one another.
       ``(B) Special rule where information is already reported or 
     submitted.--To the extent that information reported by a 
     facility to the Internal Revenue Service on Form 990, 
     information submitted by a facility to the Securities and 
     Exchange Commission, or information otherwise submitted to 
     the Secretary or any other Federal agency contains the 
     information described in clauses (i), (ii), or (iii) of 
     subparagraph (A), the facility may provide such Form or such 
     information submitted to meet the requirements of paragraph 
     (1).
       ``(C) Special rule.--In applying subparagraph (A)(i)--
       ``(i) with respect to subsections (a) and (b), `ownership 
     or control interest' shall include direct or indirect 
     interests, including such interests in intermediate entities; 
     and
       ``(ii) subsection (a)(3)(A)(ii) shall include the owner of 
     a whole or part interest in any mortgage, deed of trust, 
     note, or other obligation secured, in whole or in part, by 
     the entity or any of the property or assets thereof, if the 
     interest is equal to or exceeds 5 percent of the total 
     property or assets of the entirety.
       ``(3) Reporting.--
       ``(A) In general.--Not later than the date that is 2 years 
     after the date of the enactment of this subsection, the 
     Secretary shall promulgate final regulations requiring, 
     effective on the date that is 90 days after the date on which 
     such final regulations are published in the Federal Register, 
     a facility to report the information described in paragraph 
     (2) to the Secretary in a standardized format, and such other 
     regulations as are necessary to carry out this subsection. 
     Such final regulations shall ensure that the facility 
     certifies, as a condition of participation and payment under 
     a State health security program, that the information 
     reported by the facility in accordance with such final 
     regulations is, to the best of the facility's knowledge, 
     accurate and current.
       ``(B) Guidance.--The Secretary shall provide guidance and 
     technical assistance to States on how to adopt the 
     standardized format under subparagraph (A).
       ``(4) No effect on existing reporting requirements.--
     Nothing in this subsection shall reduce, diminish, or alter 
     any reporting requirement for a facility that is in effect as 
     of the date of the enactment of this subsection.
       ``(5) Definitions.--In this subsection:
       ``(A) Additional disclosable party.--The term `additional 
     disclosable party' means, with respect to a facility, any 
     person or entity who--
       ``(i) exercises operational, financial, or managerial 
     control over the facility or a part thereof, or provides 
     policies or procedures for any of the operations of the 
     facility, or provides financial or cash management services 
     to the facility;
       ``(ii) leases or subleases real property to the facility, 
     or owns a whole or part interest equal to or exceeding 5 
     percent of the total value of such real property; or
       ``(iii) provides management or administrative services, 
     management or clinical consulting services, or accounting or 
     financial services to the facility.
       ``(B) Facility.--The term `facility' means a disclosing 
     entity which is--
       ``(i) a skilled nursing facility (as defined in section 
     1819(a)); or
       ``(ii) a nursing facility (as defined in section 1919(a)).
       ``(C) Managing employee.--The term `managing employee' 
     means, with respect to a facility, an individual (including a 
     general manager, business manager, administrator, director, 
     or consultant) who directly or indirectly manages, advises, 
     or supervises any element of the practices, finances, or 
     operations of the facility.
       ``(D) Organizational structure.--The term `organizational 
     structure' means, in the case of--
       ``(i) a corporation, the officers, directors, and 
     shareholders of the corporation who have an ownership 
     interest in the corporation which is equal to or exceeds 5 
     percent;
       ``(ii) a limited liability company, the members and 
     managers of the limited liability company (including, as 
     applicable, what percentage each member and manager has of 
     the ownership interest in the limited liability company);
       ``(iii) a general partnership, the partners of the general 
     partnership;
       ``(iv) a limited partnership, the general partners and any 
     limited partners of the limited partnership who have an 
     ownership interest in the limited partnership which is equal 
     to or exceeds 10 percent;
       ``(v) a trust, the trustees of the trust;
       ``(vi) an individual, contact information for the 
     individual; and
       ``(vii) any other person or entity, such information as the 
     Secretary determines appropriate.''.
       (b) Public Availability of Information.--Not later than the 
     date that is 1 year after the date on which the final 
     regulations promulgated under section 1124(c)(3)(A) of the 
     Social Security Act, as added by subsection (a), are 
     published in the Federal Register, the Secretary of Health 
     and Human Services

[[Page S12231]]

     shall make the information reported in accordance with such 
     final regulations available to the public in accordance with 
     procedures established by the Secretary.
       (c) Conforming Amendments.--
       (1) In general.--
       (A) Skilled nursing facilities.--Section 1819(d)(1) of the 
     Social Security Act (42 U.S.C. 1395i-3(d)(1)) is amended by 
     striking subparagraph (B) and redesignating subparagraph (C) 
     as subparagraph (B).
       (B) Nursing facilities.--Section 1919(d)(1) of the Social 
     Security Act (42 U.S.C. 1396r(d)(1)) is amended by striking 
     subparagraph (B) and redesignating subparagraph (C) as 
     subparagraph (B).
       (2) Effective date.--The amendments made by paragraph (1) 
     shall take effect on the date on which the Secretary makes 
     the information described in subsection (b)(1) available to 
     the public under such subsection.

     SEC. 5102. ACCOUNTABILITY REQUIREMENTS FOR SKILLED NURSING 
                   FACILITIES AND NURSING FACILITIES.

       Part A of title XI of the Social Security Act (42 U.S.C. 
     1301 et seq.), as amended by sections 5001 and 5002, is 
     amended by inserting after section 1128H the following new 
     section:

     ``SEC. 1128I. ACCOUNTABILITY REQUIREMENTS FOR FACILITIES.

       ``(a) Definition of Facility.--In this section, the term 
     `facility' means--
       ``(1) a skilled nursing facility (as defined in section 
     1819(a)); or
       ``(2) a nursing facility (as defined in section 1919(a)).
       ``(b) Effective Compliance and Ethics Programs.--
       ``(1) Requirement.--On or after the date that is 36 months 
     after the date of the enactment of this section, a facility 
     shall, with respect to the entity that operates the facility 
     (in this subparagraph referred to as the `operating 
     organization' or `organization'), have in operation a 
     compliance and ethics program that is effective in preventing 
     and detecting criminal, civil, and administrative violations 
     under this Act and in promoting quality of care consistent 
     with regulations developed under paragraph (2).
       ``(2) Development of regulations.--
       ``(A) In general.--Not later than the date that is 2 years 
     after such date of the enactment, the Secretary, working 
     jointly with the Inspector General of the Department of 
     Health and Human Services, shall promulgate regulations for 
     an effective compliance and ethics program for operating 
     organizations, which may include a model compliance program.
       ``(B)  Design of regulations.--Such regulations with 
     respect to specific elements or formality of a program shall, 
     in the case of an organization that operates 5 or more 
     facilities, vary with the size of the organization, such that 
     larger organizations should have a more formal program and 
     include established written policies defining the standards 
     and procedures to be followed by its employees. Such 
     requirements may specifically apply to the corporate level 
     management of multi unit nursing home chains.
       ``(C) Evaluation.--Not later than 3 years after the date of 
     the promulgation of regulations under this paragraph, the 
     Secretary shall complete an evaluation of the compliance and 
     ethics programs required to be established under this 
     subsection. Such evaluation shall determine if such programs 
     led to changes in deficiency citations, changes in quality 
     performance, or changes in other metrics of patient quality 
     of care. The Secretary shall submit to Congress a report on 
     such evaluation and shall include in such report such 
     recommendations regarding changes in the requirements for 
     such programs as the Secretary determines appropriate.
       ``(3) Requirements for compliance and ethics programs.--In 
     this subsection, the term `compliance and ethics program' 
     means, with respect to a facility, a program of the operating 
     organization that--
       ``(A) has been reasonably designed, implemented, and 
     enforced so that it generally will be effective in preventing 
     and detecting criminal, civil, and administrative violations 
     under this Act and in promoting quality of care; and
       ``(B) includes at least the required components specified 
     in paragraph (4).
       ``(4) Required components of program.--The required 
     components of a compliance and ethics program of an operating 
     organization are the following:
       ``(A) The organization must have established compliance 
     standards and procedures to be followed by its employees and 
     other agents that are reasonably capable of reducing the 
     prospect of criminal, civil, and administrative violations 
     under this Act.
       ``(B) Specific individuals within high-level personnel of 
     the organization must have been assigned overall 
     responsibility to oversee compliance with such standards and 
     procedures and have sufficient resources and authority to 
     assure such compliance.
       ``(C) The organization must have used due care not to 
     delegate substantial discretionary authority to individuals 
     whom the organization knew, or should have known through the 
     exercise of due diligence, had a propensity to engage in 
     criminal, civil, and administrative violations under this 
     Act.
       ``(D) The organization must have taken steps to communicate 
     effectively its standards and procedures to all employees and 
     other agents, such as by requiring participation in training 
     programs or by disseminating publications that explain in a 
     practical manner what is required.
       ``(E) The organization must have taken reasonable steps to 
     achieve compliance with its standards, such as by utilizing 
     monitoring and auditing systems reasonably designed to detect 
     criminal, civil, and administrative violations under this Act 
     by its employees and other agents and by having in place and 
     publicizing a reporting system whereby employees and other 
     agents could report violations by others within the 
     organization without fear of retribution.
       ``(F) The standards must have been consistently enforced 
     through appropriate disciplinary mechanisms, including, as 
     appropriate, discipline of individuals responsible for the 
     failure to detect an offense.
       ``(G) After an offense has been detected, the organization 
     must have taken all reasonable steps to respond appropriately 
     to the offense and to prevent further similar offenses, 
     including any necessary modification to its program to 
     prevent and detect criminal, civil, and administrative 
     violations under this Act.
       ``(H) The organization must periodically undertake 
     reassessment of its compliance program to identify changes 
     necessary to reflect changes within the organization and its 
     facilities.
       ``(c) Quality Assurance and Performance Improvement 
     Program.--
       ``(1) In general.--Not later than December 31, 2011, the 
     Secretary shall establish and implement a quality assurance 
     and performance improvement program (in this subparagraph 
     referred to as the `QAPI program') for facilities, including 
     multi unit chains of facilities. Under the QAPI program, the 
     Secretary shall establish standards relating to quality 
     assurance and performance improvement with respect to 
     facilities and provide technical assistance to facilities on 
     the development of best practices in order to meet such 
     standards. Not later than 1 year after the date on which the 
     regulations are promulgated under paragraph (2), a facility 
     must submit to the Secretary a plan for the facility to meet 
     such standards and implement such best practices, including 
     how to coordinate the implementation of such plan with 
     quality assessment and assurance activities conducted under 
     sections 1819(b)(1)(B) and 1919(b)(1)(B), as applicable.
       ``(2) Regulations.--The Secretary shall promulgate 
     regulations to carry out this subsection.''.

     SEC. 5104. STANDARDIZED COMPLAINT FORM.

       (a) In General.--Section 1128I of the Social Security Act, 
     as added and amended by this Act, is amended by adding at the 
     end the following new subsection:
       ``(f) Standardized Complaint Form.--
       ``(1) Development by the secretary.--The Secretary shall 
     develop a standardized complaint form for use by a resident 
     (or a person acting on the resident's behalf) in filing a 
     complaint with a State survey and certification agency and a 
     State long-term care ombudsman program with respect to a 
     facility.
       ``(2) Complaint forms and resolution processes.--
       ``(A) Complaint forms.--The State must make the 
     standardized complaint form developed under paragraph (1) 
     available upon request to--
       ``(i) a resident of a facility; and
       ``(ii) any person acting on the resident's behalf.
       ``(B) Complaint resolution process.--The State must 
     establish a complaint resolution process in order to ensure 
     that the legal representative of a resident of a facility or 
     other responsible party is not denied access to such resident 
     or otherwise retaliated against if they have complained about 
     the quality of care provided by the facility or other issues 
     relating to the facility. Such complaint resolution process 
     shall include--
       ``(i) procedures to assure accurate tracking of complaints 
     received, including notification to the complainant that a 
     complaint has been received;
       ``(ii) procedures to determine the likely severity of a 
     complaint and for the investigation of the complaint; and
       ``(iii) deadlines for responding to a complaint and for 
     notifying the complainant of the outcome of the 
     investigation.
       ``(3) Rule of construction.--Nothing in this subsection 
     shall be construed as preventing a resident of a facility (or 
     a person acting on the resident's behalf) from submitting a 
     complaint in a manner or format other than by using the 
     standardized complaint form developed under paragraph (1) 
     (including submitting a complaint orally).''.
       (b) Effective Date.--The amendment made by this section 
     shall take effect 1 year after the date of the enactment of 
     this Act.

     SEC. 5105. ENSURING STAFFING ACCOUNTABILITY.

       Section 1128I of the Social Security Act, as added and 
     amended by this Act, is amended by adding at the end the 
     following new subsection:
       ``(g) Submission of Staffing Information Based on Payroll 
     Data in a Uniform Format.--Beginning not later than 2 years 
     after the date of the enactment of this subsection, and after 
     consulting with State long-term care ombudsman programs, 
     consumer advocacy groups, provider stakeholder groups, 
     employees and their representatives, and other parties the 
     Secretary deems appropriate, the Secretary shall require a 
     facility to electronically submit to the Secretary direct 
     care staffing information (including information with respect 
     to agency and contract staff) based on payroll and other

[[Page S12232]]

     verifiable and auditable data in a uniform format (according 
     to specifications established by the Secretary in 
     consultation with such programs, groups, and parties). Such 
     specifications shall require that the information submitted 
     under the preceding sentence--
       ``(1) specify the category of work a certified employee 
     performs (such as whether the employee is a registered nurse, 
     licensed practical nurse, licensed vocational nurse, 
     certified nursing assistant, therapist, or other medical 
     personnel);
       ``(2) include resident census data and information on 
     resident case mix;
       ``(3) include a regular reporting schedule; and
       ``(4) include information on employee turnover and tenure 
     and on the hours of care provided by each category of 
     certified employees referenced in paragraph (1) per resident 
     per day.

     Nothing in this subsection shall be construed as preventing 
     the Secretary from requiring submission of such information 
     with respect to specific categories, such as nursing staff, 
     before other categories of certified employees. Information 
     under this subsection with respect to agency and contract 
     staff shall be kept separate from information on employee 
     staffing.''.

                     PART II--TARGETING ENFORCEMENT

     SEC. 5111. CIVIL MONEY PENALTIES.

       (a) Skilled Nursing Facilities.--
       (1) In general.--Section 1819(h)(2)(B)(ii) of the Social 
     Security Act (42 U.S.C. 1395i-3(h)(2)(B)(ii)) is amended--
       (A) by striking ``Penalties.--The Secretary'' and inserting 
     ``penalties.--

       ``(I) In general.--Subject to subclause (II), the 
     Secretary''; and

       (B) by adding at the end the following new subclauses:

       ``(II) Reduction of civil money penalties in certain 
     circumstances.--Subject to subclause (III), in the case where 
     a facility self-reports and promptly corrects a deficiency 
     for which a penalty was imposed under this clause not later 
     than 10 calendar days after the date of such imposition, the 
     Secretary may reduce the amount of the penalty imposed by not 
     more than 50 percent.
       ``(III) Prohibitions on reduction for certain 
     deficiencies.--

       ``(aa) Repeat deficiencies.--The Secretary may not reduce 
     the amount of a penalty under subclause (II) if the Secretary 
     had reduced a penalty imposed on the facility in the 
     preceding year under such subclause with respect to a repeat 
     deficiency.
       ``(bb) Certain other deficiencies.--The Secretary may not 
     reduce the amount of a penalty under subclause (II) if the 
     penalty is imposed on the facility for a deficiency that is 
     found to result in a pattern of harm or widespread harm, 
     immediately jeopardizes the health or safety of a resident or 
     residents of the facility, or results in the death of a 
     resident of the facility.

       ``(IV) Collection of civil money penalties.--In the case of 
     a civil money penalty imposed under this clause, the 
     Secretary shall issue regulations that--

       ``(aa) subject to item (cc), not later than 30 days after 
     the imposition of the penalty, provide for the facility to 
     have the opportunity to participate in an independent 
     informal dispute resolution process which generates a written 
     record prior to the collection of such penalty;
       ``(bb) in the case where the penalty is imposed for each 
     day of noncompliance, provide that a penalty may not be 
     imposed for any day during the period beginning on the 
     initial day of the imposition of the penalty and ending on 
     the day on which the informal dispute resolution process 
     under item (aa) is completed;
       ``(cc) may provide for the collection of such civil money 
     penalty and the placement of such amounts collected in an 
     escrow account under the direction of the Secretary on the 
     earlier of the date on which the informal dispute resolution 
     process under item (aa) is completed or the date that is 90 
     days after the date of the imposition of the penalty;
       ``(dd) may provide that such amounts collected are kept in 
     such account pending the resolution of any subsequent 
     appeals;
       ``(ee) in the case where the facility successfully appeals 
     the penalty, may provide for the return of such amounts 
     collected (plus interest) to the facility; and
       ``(ff) in the case where all such appeals are unsuccessful, 
     may provide that some portion of such amounts collected may 
     be used to support activities that benefit residents, 
     including assistance to support and protect residents of a 
     facility that closes (voluntarily or involuntarily) or is 
     decertified (including offsetting costs of relocating 
     residents to home and community-based settings or another 
     facility), projects that support resident and family councils 
     and other consumer involvement in assuring quality care in 
     facilities, and facility improvement initiatives approved by 
     the Secretary (including joint training of facility staff and 
     surveyors, technical assistance for facilities implementing 
     quality assurance programs, the appointment of temporary 
     management firms, and other activities approved by the 
     Secretary).''.
       (2) Conforming amendment.--The second sentence of section 
     1819(h)(5) of the Social Security Act (42 U.S.C. 1395i-
     3(h)(5)) is amended by inserting ``(ii)(IV),'' after 
     ``(i),''.
       (b) Nursing Facilities.--
       (1) In general.--Section 1919(h)(3)(C)(ii) of the Social 
     Security Act (42 U.S.C. 1396r(h)(3)(C)) is amended--
       (A) by striking ``Penalties.--The Secretary'' and inserting 
     ``penalties.--

       ``(I) In general.--Subject to subclause (II), the 
     Secretary''; and

       (B) by adding at the end the following new subclauses:

       ``(II) Reduction of civil money penalties in certain 
     circumstances.--Subject to subclause (III), in the case where 
     a facility self-reports and promptly corrects a deficiency 
     for which a penalty was imposed under this clause not later 
     than 10 calendar days after the date of such imposition, the 
     Secretary may reduce the amount of the penalty imposed by not 
     more than 50 percent.
       ``(III) Prohibitions on reduction for certain 
     deficiencies.--

       ``(aa) Repeat deficiencies.--The Secretary may not reduce 
     the amount of a penalty under subclause (II) if the Secretary 
     had reduced a penalty imposed on the facility in the 
     preceding year under such subclause with respect to a repeat 
     deficiency.
       ``(bb) Certain other deficiencies.--The Secretary may not 
     reduce the amount of a penalty under subclause (II) if the 
     penalty is imposed on the facility for a deficiency that is 
     found to result in a pattern of harm or widespread harm, 
     immediately jeopardizes the health or safety of a resident or 
     residents of the facility, or results in the death of a 
     resident of the facility.

       ``(IV) Collection of civil money penalties.--In the case of 
     a civil money penalty imposed under this clause, the 
     Secretary shall issue regulations that--

       ``(aa) subject to item (cc), not later than 30 days after 
     the imposition of the penalty, provide for the facility to 
     have the opportunity to participate in an independent 
     informal dispute resolution process which generates a written 
     record prior to the collection of such penalty;
       ``(bb) in the case where the penalty is imposed for each 
     day of noncompliance, provide that a penalty may not be 
     imposed for any day during the period beginning on the 
     initial day of the imposition of the penalty and ending on 
     the day on which the informal dispute resolution process 
     under item (aa) is completed;
       ``(cc) may provide for the collection of such civil money 
     penalty and the placement of such amounts collected in an 
     escrow account under the direction of the Secretary on the 
     earlier of the date on which the informal dispute resolution 
     process under item (aa) is completed or the date that is 90 
     days after the date of the imposition of the penalty;
       ``(dd) may provide that such amounts collected are kept in 
     such account pending the resolution of any subsequent 
     appeals;
       ``(ee) in the case where the facility successfully appeals 
     the penalty, may provide for the return of such amounts 
     collected (plus interest) to the facility; and
       ``(ff) in the case where all such appeals are unsuccessful, 
     may provide that some portion of such amounts collected may 
     be used to support activities that benefit residents, 
     including assistance to support and protect residents of a 
     facility that closes (voluntarily or involuntarily) or is 
     decertified (including offsetting costs of relocating 
     residents to home and community-based settings or another 
     facility), projects that support resident and family councils 
     and other consumer involvement in assuring quality care in 
     facilities, and facility improvement initiatives approved by 
     the Secretary (including joint training of facility staff and 
     surveyors, technical assistance for facilities implementing 
     quality assurance programs, the appointment of temporary 
     management firms, and other activities approved by the 
     Secretary).''.
       (2) Conforming amendment.--Section 1919(h)(5)(8) of the 
     Social Security Act (42 U.S.C. 1396r(h)(5)(8)) is amended by 
     inserting ``(ii)(IV),'' after ``(i),''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect 1 year after the date of the enactment of 
     this Act.

     SEC. 5112. NATIONAL INDEPENDENT MONITOR DEMONSTRATION 
                   PROJECT.

       (a) Establishment.--
       (1) In general.--The Secretary, in consultation with the 
     Inspector General of the Department of Health and Human 
     Services, shall conduct a demonstration project to develop, 
     test, and implement an independent monitor program to oversee 
     interstate and large intrastate chains of skilled nursing 
     facilities and nursing facilities.
       (2) Selection.--The Secretary shall select chains of 
     skilled nursing facilities and nursing facilities described 
     in paragraph (1) to participate in the demonstration project 
     under this section from among those chains that submit an 
     application to the Secretary at such time, in such manner, 
     and containing such information as the Secretary may require.
       (3) Duration.--The Secretary shall conduct the 
     demonstration project under this section for a 2-year period.
       (4) Implementation.--The Secretary shall implement the 
     demonstration project under this section not later than 1 
     year after the date of the enactment of this Act.
       (b) Requirements.--The Secretary shall evaluate chains 
     selected to participate in the demonstration project under 
     this section based on criteria selected by the Secretary, 
     including where evidence suggests that a number of the 
     facilities of the chain are experiencing serious safety and 
     quality of care problems. Such criteria may include the 
     evaluation of a chain that includes a number of facilities 
     participating in the ``Special

[[Page S12233]]

     Focus Facility'' program (or a successor program) or multiple 
     facilities with a record of repeated serious safety and 
     quality of care deficiencies.
       (c) Responsibilities.--An independent monitor that enters 
     into a contract with the Secretary to participate in the 
     conduct of the demonstration project under this section 
     shall--
       (1) conduct periodic reviews and prepare root-cause quality 
     and deficiency analyses of a chain to assess if facilities of 
     the chain are in compliance with State and Federal laws and 
     regulations applicable to the facilities;
       (2) conduct sustained oversight of the efforts of the 
     chain, whether publicly or privately held, to achieve 
     compliance by facilities of the chain with State and Federal 
     laws and regulations applicable to the facilities;
       (3) analyze the management structure, distribution of 
     expenditures, and nurse staffing levels of facilities of the 
     chain in relation to resident census, staff turnover rates, 
     and tenure;
       (4) report findings and recommendations with respect to 
     such reviews, analyses, and oversight to the chain and 
     facilities of the chain, to the Secretary, and to relevant 
     States; and
       (5) publish the results of such reviews, analyses, and 
     oversight.
       (d) Implementation of Recommendations.--
       (1) Receipt of finding by chain.--Not later than 10 days 
     after receipt of a finding of an independent monitor under 
     subsection (c)(4), a chain participating in the demonstration 
     project shall submit to the independent monitor a report--
       (A) outlining corrective actions the chain will take to 
     implement the recommendations in such report; or
       (B) indicating that the chain will not implement such 
     recommendations, and why it will not do so.
       (2) Receipt of report by independent monitor.--Not later 
     than 10 days after receipt of a report submitted by a chain 
     under paragraph (1), an independent monitor shall finalize 
     its recommendations and submit a report to the chain and 
     facilities of the chain, the Secretary, and the State or 
     States, as appropriate, containing such final 
     recommendations.
       (e) Cost of Appointment.--A chain shall be responsible for 
     a portion of the costs associated with the appointment of 
     independent monitors under the demonstration project under 
     this section. The chain shall pay such portion to the 
     Secretary (in an amount and in accordance with procedures 
     established by the Secretary).
       (f) Authorization of Appropriations.--There are authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.
       (g) Definitions.--In this section:
       (1) Additional disclosable party.--The term ``additional 
     disclosable party'' has the meaning given such term in 
     section 1124(c)(5)(A) of the Social Security Act, as added by 
     section 4201(a).
       (2) Facility.--The term ``facility'' means a skilled 
     nursing facility or a nursing facility.
       (3) Nursing facility.--The term ``nursing facility'' has 
     the meaning given such term in section 1919(a) of the Social 
     Security Act (42 U.S.C. 1396r(a)).
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services, acting through the Assistant 
     Secretary for Planning and Evaluation.
       (5) Skilled nursing facility.--The term ``skilled nursing 
     facility'' has the meaning given such term in section 1819(a) 
     of the Social Security Act (42 U.S.C. 1395(a)).
       (h) Evaluation and Report.--
       (1) Evaluation.--The Secretary, in consultation with the 
     Inspector General of the Department of Health and Human 
     Services, shall evaluate the demonstration project conducted 
     under this section.
       (2) Report.--Not later than 180 days after the completion 
     of the demonstration project under this section, the 
     Secretary shall submit to Congress a report containing the 
     results of the evaluation conducted under paragraph (1), 
     together with recommendations--
       (A) as to whether the independent monitor program should be 
     established on a permanent basis;
       (B) if the Secretary recommends that such program be so 
     established, on appropriate procedures and mechanisms for 
     such establishment; and
       (C) for such legislation and administrative action as the 
     Secretary determines appropriate.

     SEC. 5113. NOTIFICATION OF FACILITY CLOSURE.

       (a) In General.--Section 1128I of the Social Security Act, 
     as added and amended by this Act, is amended by adding at the 
     end the following new subsection:
       ``(h) Notification of Facility Closure.--
       ``(1) In general.--Any individual who is the administrator 
     of a facility must--
       ``(A) submit to the Secretary, the State long-term care 
     ombudsman, residents of the facility, and the legal 
     representatives of such residents or other responsible 
     parties, written notification of an impending closure--
       ``(i) subject to clause (ii), not later than the date that 
     is 60 days prior to the date of such closure; and
       ``(ii) in the case of a facility where the Secretary 
     terminates the facility's participation under this title, not 
     later than the date that the Secretary determines 
     appropriate;
       ``(B) ensure that the facility does not admit any new 
     residents on or after the date on which such written 
     notification is submitted; and
       ``(C) include in the notice a plan for the transfer and 
     adequate relocation of the residents of the facility by a 
     specified date prior to closure that has been approved by the 
     State, including assurances that the residents will be 
     transferred to the most appropriate facility or other setting 
     in terms of quality, services, and location, taking into 
     consideration the needs, choice, and best interests of each 
     resident.
       ``(2) Relocation.--
       ``(A) In general.--The State shall ensure that, before a 
     facility closes, all residents of the facility have been 
     successfully relocated to another facility or an alternative 
     home and community-based setting.
       ``(B) Continuation of payments until residents relocated.--
     The Secretary may, as the Secretary determines appropriate, 
     continue to make payments under this title with respect to 
     residents of a facility that has submitted a notification 
     under paragraph (1) during the period beginning on the date 
     such notification is submitted and ending on the date on 
     which the resident is successfully relocated.
       ``(3) Sanctions.--Any individual who is the administrator 
     of a facility that fails to comply with the requirements of 
     paragraph (1)--
       ``(A) shall be subject to a civil monetary penalty of up to 
     $100,000;
       ``(B) may be subject to exclusion from participation in any 
     Federal health care program (as defined in section 1128B(f)); 
     and
       ``(C) shall be subject to any other penalties that may be 
     prescribed by law.
       ``(4) Procedure.--The provisions of section 1128A (other 
     than subsections (a) and (b) and the second sentence of 
     subsection (f)) shall apply to a civil money penalty or 
     exclusion under paragraph (3) in the same manner as such 
     provisions apply to a penalty or proceeding under section 
     1128A(a).''.
       (b) Conforming Amendments.--Section 1819(h)(4) of the 
     Social Security Act (42 U.S.C. 1395i-3(h)(4)) is amended--
       (1) in the first sentence, by striking ``the Secretary 
     shall terminate'' and inserting ``the Secretary, subject to 
     section 1128I(h), shall terminate''; and
       (2) in the second sentence, by striking ``subsection 
     (c)(2)'' and inserting ``subsection (c)(2) and section 
     1128I(h)''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect 1 year after the date of the enactment of 
     this Act.

     SEC. 5114. NATIONAL DEMONSTRATION PROJECTS ON CULTURE CHANGE 
                   AND USE OF INFORMATION TECHNOLOGY IN NURSING 
                   HOMES.

       (a) In General.--The Secretary shall conduct 2 
     demonstration projects, 1 for the development of best 
     practices in skilled nursing facilities and nursing 
     facilities that are involved in the culture change movement 
     (including the development of resources for facilities to 
     find and access funding in order to undertake culture change) 
     and 1 for the development of best practices in skilled 
     nursing facilities and nursing facilities for the use of 
     information technology to improve resident care.
       (b) Conduct of Demonstration Projects.--
       (1) Grant award.--Under each demonstration project 
     conducted under this section, the Secretary shall award 1 or 
     more grants to facility-based settings for the development of 
     best practices described in subsection (a) with respect to 
     the demonstration project involved. Such award shall be made 
     on a competitive basis and may be allocated in 1 lump-sum 
     payment.
       (2) Consideration of special needs of residents.--Each 
     demonstration project conducted under this section shall take 
     into consideration the special needs of residents of skilled 
     nursing facilities and nursing facilities who have cognitive 
     impairment, including dementia.
       (c) Duration and Implementation.--
       (1) Duration.--The demonstration projects shall each be 
     conducted for a period not to exceed 3 years.
       (2) Implementation.--The demonstration projects shall each 
     be implemented not later than 1 year after the date of the 
     enactment of this Act.
       (d) Definitions.--In this section:
       (1) Nursing facility.--The term ``nursing facility'' has 
     the meaning given such term in section 1919(a) of the Social 
     Security Act (42 U.S.C. 1396r(a)).
       (2) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (3) Skilled nursing facility.--The term ``skilled nursing 
     facility'' has the meaning given such term in section 1819(a) 
     of the Social Security Act (42 U.S.C. 1395(a)).
       (e) Authorization of Appropriations.--There are authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.
       (f) Report.--Not later than 9 months after the completion 
     of the demonstration project, the Secretary shall submit to 
     Congress a report on such project, together with 
     recommendations for such legislation and administrative 
     action as the Secretary determines appropriate.

                   PART III--IMPROVING STAFF TRAINING

     SEC. 5121. DEMENTIA AND ABUSE PREVENTION TRAINING.

       (a) Skilled Nursing Facilities.--
       (1) In general.--Section 1819(f)(2)(A)(i)(I) of the Social 
     Security Act (42 U.S.C. 1395i-3(f)(2)(A)(i)(I)) is amended by 
     inserting ``(including, in the case of initial training and, 
     if the Secretary determines appropriate, in the

[[Page S12234]]

     case of ongoing training, dementia management training, and 
     patient abuse prevention training'' before ``, (II)''.
       (2) Clarification of definition of nurse aide.--Section 
     1819(b)(5)(F) of the Social Security Act (42 U.S.C. 1395i-
     3(b)(5)(F)) is amended by adding at the end the following 
     flush sentence:
     ``Such term includes an individual who provides such services 
     through an agency or under a contract with the facility.''.
       (b) Nursing Facilities.--
       (1) In general.--Section 1919(f)(2)(A)(i)(I) of the Social 
     Security Act (42 U.S.C. 1396r(f)(2)(A)(i)(I)) is amended by 
     inserting ``(including, in the case of initial training and, 
     if the Secretary determines appropriate, in the case of 
     ongoing training, dementia management training, and patient 
     abuse prevention training'' before ``, (II)''.
       (2) Clarification of definition of nurse aide.--Section 
     1919(b)(5)(F) of the Social Security Act (42 U.S.C. 
     1396r(b)(5)(F)) is amended by adding at the end the following 
     flush sentence:
     ``Such term includes an individual who provides such services 
     through an agency or under a contract with the facility.''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect 1 year after the date of the enactment of 
     this Act.

Subtitle C--Nationwide Program for National and State Background Checks 
  on Direct Patient Access Employees of Long-Term Care Facilities and 
                               Providers

     SEC. 5201. NATIONWIDE PROGRAM FOR NATIONAL AND STATE 
                   BACKGROUND CHECKS ON DIRECT PATIENT ACCESS 
                   EMPLOYEES OF LONG-TERM CARE FACILITIES AND 
                   PROVIDERS.

       (a) In General.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary''), shall 
     establish a program to identify efficient, effective, and 
     economical procedures for long term care facilities or 
     providers to conduct background checks on prospective direct 
     patient access employees on a nationwide basis (in this 
     subsection, such program shall be referred to as the 
     ``nationwide program''). Except for the following 
     modifications, the Secretary shall carry out the nationwide 
     program under similar terms and conditions as the pilot 
     program under section 307 of the Medicare Prescription Drug, 
     Improvement, and Modernization Act of 2003 (Public Law 108-
     173; 117 Stat. 2257), including the prohibition on hiring 
     abusive workers and the authorization of the imposition of 
     penalties by a participating State under subsection (b)(3)(A) 
     and (b)(6), respectively, of such section 307:
       (1) Agreements.--
       (A) Newly participating states.--The Secretary shall enter 
     into agreements with each State--
       (i) that the Secretary has not entered into an agreement 
     with under subsection (c)(1) of such section 307;
       (ii) that agrees to conduct background checks under the 
     nationwide program on a Statewide basis; and
       (iii) that submits an application to the Secretary 
     containing such information and at such time as the Secretary 
     may specify.
       (B) Certain previously participating states.--The Secretary 
     shall enter into agreements with each State--
       (i) that the Secretary has entered into an agreement with 
     under such subsection (c)(1), but only in the case where such 
     agreement did not require the State to conduct background 
     checks under the program established under subsection (a) of 
     such section 307 on a Statewide basis;
       (ii) that agrees to conduct background checks under the 
     nationwide program on a Statewide basis; and
       (iii) that submits an application to the Secretary 
     containing such information and at such time as the Secretary 
     may specify.
       (2) Nonapplication of selection criteria.--The selection 
     criteria required under subsection (c)(3)(B) of such section 
     307 shall not apply.
       (3) Required fingerprint check as part of criminal history 
     background check.--The procedures established under 
     subsection (b)(1) of such section 307 shall--
       (A) require that the long-term care facility or provider 
     (or the designated agent of the long-term care facility or 
     provider) obtain State and national criminal history 
     background checks on the prospective employee through such 
     means as the Secretary determines appropriate, efficient, and 
     effective that utilize a search of State-based abuse and 
     neglect registries and databases, including the abuse and 
     neglect registries of another State in the case where a 
     prospective employee previously resided in that State, State 
     criminal history records, the records of any proceedings in 
     the State that may contain disqualifying information about 
     prospective employees (such as proceedings conducted by State 
     professional licensing and disciplinary boards and State 
     Medicaid Fraud Control Units), and Federal criminal history 
     records, including a fingerprint check using the Integrated 
     Automated Fingerprint Identification System of the Federal 
     Bureau of Investigation;
       (B) require States to describe and test methods that reduce 
     duplicative fingerprinting, including providing for the 
     development of ``rap back'' capability by the State such 
     that, if a direct patient access employee of a long-term care 
     facility or provider is convicted of a crime following the 
     initial criminal history background check conducted with 
     respect to such employee, and the employee's fingerprints 
     match the prints on file with the State law enforcement 
     department, the department will immediately inform the State 
     and the State will immediately inform the long-term care 
     facility or provider which employs the direct patient access 
     employee of such conviction; and
       (C) require that criminal history background checks 
     conducted under the nationwide program remain valid for a 
     period of time specified by the Secretary.
       (4) State requirements.--An agreement entered into under 
     paragraph (1) shall require that a participating State--
       (A) be responsible for monitoring compliance with the 
     requirements of the nationwide program;
       (B) have procedures in place to--
       (i) conduct screening and criminal history background 
     checks under the nationwide program in accordance with the 
     requirements of this section;
       (ii) monitor compliance by long-term care facilities and 
     providers with the procedures and requirements of the 
     nationwide program;
       (iii) as appropriate, provide for a provisional period of 
     employment by a long-term care facility or provider of a 
     direct patient access employee, not to exceed 60 days, 
     pending completion of the required criminal history 
     background check and, in the case where the employee has 
     appealed the results of such background check, pending 
     completion of the appeals process, during which the employee 
     shall be subject to direct on-site supervision (in accordance 
     with procedures established by the State to ensure that a 
     long-term care facility or provider furnishes such direct on-
     site supervision);
       (iv) provide an independent process by which a provisional 
     employee or an employee may appeal or dispute the accuracy of 
     the information obtained in a background check performed 
     under the nationwide program, including the specification of 
     criteria for appeals for direct patient access employees 
     found to have disqualifying information which shall include 
     consideration of the passage of time, extenuating 
     circumstances, demonstration of rehabilitation, and relevancy 
     of the particular disqualifying information with respect to 
     the current employment of the individual;
       (v) provide for the designation of a single State agency as 
     responsible for--

       (I) overseeing the coordination of any State and national 
     criminal history background checks requested by a long-term 
     care facility or provider (or the designated agent of the 
     long-term care facility or provider) utilizing a search of 
     State and Federal criminal history records, including a 
     fingerprint check of such records;
       (II) overseeing the design of appropriate privacy and 
     security safeguards for use in the review of the results of 
     any State or national criminal history background checks 
     conducted regarding a prospective direct patient access 
     employee to determine whether the employee has any conviction 
     for a relevant crime;
       (III) immediately reporting to the long-term care facility 
     or provider that requested the criminal history background 
     check the results of such review; and
       (IV) in the case of an employee with a conviction for a 
     relevant crime that is subject to reporting under section 
     1128E of the Social Security Act (42 U.S.C. 1320a-7e), 
     reporting the existence of such conviction to the database 
     established under that section;

       (vi) determine which individuals are direct patient access 
     employees (as defined in paragraph (6)(B)) for purposes of 
     the nationwide program;
       (vii) as appropriate, specify offenses, including 
     convictions for violent crimes, for purposes of the 
     nationwide program; and
       (viii) describe and test methods that reduce duplicative 
     fingerprinting, including providing for the development of 
     ``rap back'' capability such that, if a direct patient access 
     employee of a long-term care facility or provider is 
     convicted of a crime following the initial criminal history 
     background check conducted with respect to such employee, and 
     the employee's fingerprints match the prints on file with the 
     State law enforcement department--

       (I) the department will immediately inform the State agency 
     designated under clause (v) and such agency will immediately 
     inform the facility or provider which employs the direct 
     patient access employee of such conviction; and
       (II) the State will provide, or will require the facility 
     to provide, to the employee a copy of the results of the 
     criminal history background check conducted with respect to 
     the employee at no charge in the case where the individual 
     requests such a copy.

       (5) Payments.--
       (A) Newly participating states.--
       (i) In general.--As part of the application submitted by a 
     State under paragraph (1)(A)(iii), the State shall guarantee, 
     with respect to the costs to be incurred by the State in 
     carrying out the nationwide program, that the State will make 
     available (directly or through donations from public or 
     private entities) a particular amount of non-Federal 
     contributions, as a condition of receiving the Federal match 
     under clause (ii).
       (ii) Federal match.--The payment amount to each State that 
     the Secretary enters into an agreement with under paragraph 
     (1)(A) shall be 3 times the amount that the State guarantees 
     to make available under clause (i), except that in no case 
     may the payment amount exceed $3,000,000.
       (B) Previously participating states.--

[[Page S12235]]

       (i) In general.--As part of the application submitted by a 
     State under paragraph (1)(B)(iii), the State shall guarantee, 
     with respect to the costs to be incurred by the State in 
     carrying out the nationwide program, that the State will make 
     available (directly or through donations from public or 
     private entities) a particular amount of non-Federal 
     contributions, as a condition of receiving the Federal match 
     under clause (ii).
       (ii) Federal match.--The payment amount to each State that 
     the Secretary enters into an agreement with under paragraph 
     (1)(B) shall be 3 times the amount that the State guarantees 
     to make available under clause (i), except that in no case 
     may the payment amount exceed $1,500,000.
       (6) Definitions.--Under the nationwide program:
       (A) Conviction for a relevant crime.--The term ``conviction 
     for a relevant crime'' means any Federal or State criminal 
     conviction for--
       (i) any offense described in section 1128(a) of the Social 
     Security Act (42 U.S.C. 1320a-7); or
       (ii) such other types of offenses as a participating State 
     may specify for purposes of conducting the program in such 
     State.
       (B) Disqualifying information.--The term ``disqualifying 
     information'' means a conviction for a relevant crime or a 
     finding of patient or resident abuse.
       (C) Finding of patient or resident abuse.--The term 
     ``finding of patient or resident abuse'' means any 
     substantiated finding by a State agency under section 
     1819(g)(1)(C) or 1919(g)(1)(C) of the Social Security Act (42 
     U.S.C. 1395i-3(g)(1)(C), 1396r(g)(1)(C)) or a Federal agency 
     that a direct patient access employee has committed--
       (i) an act of patient or resident abuse or neglect or a 
     misappropriation of patient or resident property; or
       (ii) such other types of acts as a participating State may 
     specify for purposes of conducting the program in such State.
       (D) Direct patient access employee.--The term ``direct 
     patient access employee'' means any individual who has access 
     to a patient or resident of a long-term care facility or 
     provider through employment or through a contract with such 
     facility or provider and has duties that involve (or may 
     involve) one-on-one contact with a patient or resident of the 
     facility or provider, as determined by the State for purposes 
     of the nationwide program. Such term does not include a 
     volunteer unless the volunteer has duties that are equivalent 
     to the duties of a direct patient access employee and those 
     duties involve (or may involve) one-on-one contact with a 
     patient or resident of the long-term care facility or 
     provider.
       (E) Long-term care facility or provider.--The term ``long-
     term care facility or provider'' means the following 
     facilities or providers which receive payment for services 
     under a State health security program:
       (i) A skilled nursing facility (as defined in section 
     1819(a) of the Social Security Act (42 U.S.C. 1395i-3(a))).
       (ii) A nursing facility (as defined in section 1919(a) of 
     such Act (42 U.S.C. 1396r(a))).
       (iii) A home health agency.
       (iv) A provider of hospice care (as defined in section 
     1861(dd)(1) of such Act (42 U.S.C. 1395x(dd)(1))).
       (v) A long-term care hospital (as described in section 
     1886(d)(1)(B)(iv) of such Act (42 U.S.C. 
     1395ww(d)(1)(B)(iv))).
       (vi) A provider of personal care services.
       (vii) A provider of adult day care.
       (viii) A residential care provider that arranges for, or 
     directly provides, long-term care services, including an 
     assisted living facility that provides a level of care 
     established by the Secretary.
       (ix) An intermediate care facility for the mentally 
     retarded (as defined in section 1905(d) of such Act (42 
     U.S.C. 1396d(d))).
       (x) Any other facility or provider of long-term care 
     services under such titles as the participating State 
     determines appropriate.
       (7) Evaluation and report.--
       (A) Evaluation.--
       (i) In general.--The Inspector General of the Department of 
     Health and Human Services shall conduct an evaluation of the 
     nationwide program.
       (ii) Inclusion of specific topics.--The evaluation 
     conducted under clause (i) shall include the following:

       (I) A review of the various procedures implemented by 
     participating States for long-term care facilities or 
     providers, including staffing agencies, to conduct background 
     checks of direct patient access employees under the 
     nationwide program and identification of the most 
     appropriate, efficient, and effective procedures for 
     conducting such background checks.
       (II) An assessment of the costs of conducting such 
     background checks (including start up and administrative 
     costs).
       (III) A determination of the extent to which conducting 
     such background checks leads to any unintended consequences, 
     including a reduction in the available workforce for long-
     term care facilities or providers.
       (IV) An assessment of the impact of the nationwide program 
     on reducing the number of incidents of neglect, abuse, and 
     misappropriation of resident property to the extent 
     practicable.
       (V) An evaluation of other aspects of the nationwide 
     program, as determined appropriate by the Secretary.

       (B) Report.--Not later than 180 days after the completion 
     of the nationwide program, the Inspector General of the 
     Department of Health and Human Services shall submit a report 
     to Congress containing the results of the evaluation 
     conducted under subparagraph (A).
       (b) Funding.--
       (1) Notification.--The Secretary of Health and Human 
     Services shall notify the Secretary of the Treasury of the 
     amount necessary to carry out the nationwide program under 
     this section for the period of fiscal years 2010 through 
     2012, except that in no case shall such amount exceed 
     $160,000,000.
       (2) Transfer of funds.--
       (A) In general.--Out of any funds in the Treasury not 
     otherwise appropriated, the Secretary of the Treasury shall 
     provide for the transfer to the Secretary of Health and Human 
     Services of the amount specified as necessary to carry out 
     the nationwide program under paragraph (1). Such amount shall 
     remain available until expended.
       (B) Reservation of funds for conduct of evaluation.--The 
     Secretary may reserve not more than $3,000,000 of the amount 
     transferred under subparagraph (A) to provide for the conduct 
     of the evaluation under subsection (a)(7)(A).

             Subtitle D--Patient-Centered Outcomes Research

     SEC. 5301. PATIENT-CENTERED OUTCOMES RESEARCH.

       Title XI of the Social Security Act (42 U.S.C. 1301 et 
     seq.) is amended by adding at the end the following new part:

         ``Part D--Comparative Clinical Effectiveness Research


             ``comparative clinical effectiveness research

       ``Sec. 1181.  (a) Definitions.--In this section:
       ``(1) Board.--The term `Board' means the Board of Governors 
     established under subsection (f).
       ``(2) Comparative clinical effectiveness research; 
     research.--
       ``(A) In general.--The terms `comparative clinical 
     effectiveness research' and `research' mean research 
     evaluating and comparing health outcomes and the clinical 
     effectiveness, risks, and benefits of 2 or more medical 
     treatments, services, and items described in subparagraph 
     (B).
       ``(B) Medical treatments, services, and items described.--
     The medical treatments, services, and items described in this 
     subparagraph are health care interventions, protocols for 
     treatment, care management, and delivery, procedures, medical 
     devices, diagnostic tools, pharmaceuticals (including drugs 
     and biologicals), integrative health practices, and any other 
     strategies or items being used in the treatment, management, 
     and diagnosis of, or prevention of illness or injury in, 
     individuals.
       ``(3) Conflict of interest.--The term `conflict of 
     interest' means an association, including a financial or 
     personal association, that have the potential to bias or have 
     the appearance of biasing an individual's decisions in 
     matters related to the Institute or the conduct of activities 
     under this section.
       ``(4) Real conflict of interest.--The term `real conflict 
     of interest' means any instance where a member of the Board, 
     the methodology committee established under subsection 
     (d)(6), or an advisory panel appointed under subsection 
     (d)(4), or a close relative of such member, has received or 
     could receive either of the following:
       ``(A) A direct financial benefit of any amount deriving 
     from the result or findings of a study conducted under this 
     section.
       ``(B) A financial benefit from individuals or companies 
     that own or manufacture medical treatments, services, or 
     items to be studied under this section that in the aggregate 
     exceeds $10,000 per year. For purposes of the preceding 
     sentence, a financial benefit includes honoraria, fees, 
     stock, or other financial benefit and the current value of 
     the member or close relative's already existing stock 
     holdings, in addition to any direct financial benefit 
     deriving from the results or findings of a study conducted 
     under this section.
       ``(b) Patient-Centered Outcomes Research Institute.--
       ``(1) Establishment.--There is authorized to be established 
     a nonprofit corporation, to be known as the `Patient-Centered 
     Outcomes Research Institute' (referred to in this section as 
     the `Institute') which is neither an agency nor establishment 
     of the United States Government.
       ``(2) Application of provisions.--The Institute shall be 
     subject to the provisions of this section, and, to the extent 
     consistent with this section, to the District of Columbia 
     Nonprofit Corporation Act.
       ``(c) Purpose.--The purpose of the Institute is to assist 
     patients, clinicians, purchasers, and policy-makers in making 
     informed health decisions by advancing the quality and 
     relevance of evidence concerning the manner in which 
     diseases, disorders, and other health conditions can 
     effectively and appropriately be prevented, diagnosed, 
     treated, monitored, and managed through research and evidence 
     synthesis that considers variations in patient 
     subpopulations, and the dissemination of research findings 
     with respect to the relative health outcomes, clinical 
     effectiveness, and appropriateness of the medical treatments, 
     services, and items described in subsection (a)(2)(B).
       ``(d) Duties.--
       ``(1) Identifying research priorities and establishing 
     research project agenda.--

[[Page S12236]]

       ``(A) Identifying research priorities.--The Institute shall 
     identify national priorities for research, taking into 
     account factors of disease incidence, prevalence, and burden 
     in the United States (with emphasis on chronic conditions), 
     gaps in evidence in terms of clinical outcomes, practice 
     variations and health disparities in terms of delivery and 
     outcomes of care, the potential for new evidence to improve 
     patient health, well-being, and the quality of care, the 
     effect on national expenditures associated with a health care 
     treatment, strategy, or health conditions, as well as patient 
     needs, outcomes, and preferences, the relevance to patients 
     and clinicians in making informed health decisions, and 
     priorities in the National Strategy for quality care 
     established under section 399H of the Public Health Service 
     Act that are consistent with this section.
       ``(B) Establishing research project agenda.--The Institute 
     shall establish and update a research project agenda for 
     research to address the priorities identified under 
     subparagraph (A), taking into consideration the types of 
     research that might address each priority and the relative 
     value (determined based on the cost of conducting research 
     compared to the potential usefulness of the information 
     produced by research) associated with the different types of 
     research, and such other factors as the Institute determines 
     appropriate.
       ``(2) Carrying out research project agenda.--
       ``(A) Research.--The Institute shall carry out the research 
     project agenda established under paragraph (1)(B) in 
     accordance with the methodological standards adopted under 
     paragraph (9) using methods, including the following:
       ``(i) Systematic reviews and assessments of existing and 
     future research and evidence including original research 
     conducted subsequent to the date of the enactment of this 
     section.
       ``(ii) Primary research, such as randomized clinical 
     trials, molecularly informed trials, and observational 
     studies.
       ``(iii) Any other methodologies recommended by the 
     methodology committee established under paragraph (6) that 
     are adopted by the Board under paragraph (9).
       ``(B) Contracts for the management of funding and conduct 
     of research.--
       ``(i) Contracts.--

       ``(I) In general.--In accordance with the research project 
     agenda established under paragraph (1)(B), the Institute 
     shall enter into contracts for the management of funding and 
     conduct of research in accordance with the following:

       ``(aa) Appropriate agencies and instrumentalities of the 
     Federal Government.
       ``(bb) Appropriate academic research, private sector 
     research, or study-conducting entities.

       ``(II) Preference.--In entering into contracts under 
     subclause (I), the Institute shall give preference to the 
     Agency for Healthcare Research and Quality and the National 
     Institutes of Health, but only if the research to be 
     conducted or managed under such contract is authorized by the 
     governing statutes of such Agency or Institutes.

       ``(ii) Conditions for contracts.--A contract entered into 
     under this subparagraph shall require that the agency, 
     instrumentality, or other entity--

       ``(I) abide by the transparency and conflicts of interest 
     requirements under subsection (h) that apply to the Institute 
     with respect to the research managed or conducted under such 
     contract;
       ``(II) comply with the methodological standards adopted 
     under paragraph (9) with respect to such research;
       ``(III) consult with the expert advisory panels for 
     clinical trials and rare disease appointed under clauses (ii) 
     and (iii), respectively, of paragraph (4)(A);
       ``(IV) subject to clause (iv), permit a researcher who 
     conducts original research under the contract for the agency, 
     instrumentality, or other entity to have such research 
     published in a peer-reviewed journal or other publication;
       ``(V) have appropriate processes in place to manage data 
     privacy and meet ethical standards for the research;
       ``(VI) comply with the requirements of the Institute for 
     making the information available to the public under 
     paragraph (8); and
       ``(VII) comply with other terms and conditions determined 
     necessary by the Institute to carry out the research agenda 
     adopted under paragraph (2).

       ``(iii) Coverage of copayments or coinsurance.--A contract 
     entered into under this subparagraph may allow for the 
     coverage of copayments or coinsurance, or allow for other 
     appropriate measures, to the extent that such coverage or 
     other measures are necessary to preserve the validity of a 
     research project, such as in the case where the research 
     project must be blinded.
       ``(iv) Requirements for publication of research.--Any 
     research published under clause (ii)(IV) shall be within the 
     bounds of and entirely consistent with the evidence and 
     findings produced under the contract with the Institute under 
     this subparagraph. If the Institute determines that those 
     requirements are not met, the Institute shall not enter into 
     another contract with the agency, instrumentality, or entity 
     which managed or conducted such research for a period 
     determined appropriate by the Institute (but not less than 5 
     years).
       ``(C) Review and update of evidence.--The Institute shall 
     review and update evidence on a periodic basis as 
     appropriate.
       ``(D) Taking into account potential differences.--Research 
     shall be designed, as appropriate, to take into account the 
     potential for differences in the effectiveness of health care 
     treatments, services, and items as used with various 
     subpopulations, such as racial and ethnic minorities, women, 
     age, and groups of individuals with different comorbidities, 
     genetic and molecular sub-types, or quality of life 
     preferences and include members of such subpopulations as 
     subjects in the research as feasible and appropriate.
       ``(E) Differences in treatment modalities.--Research shall 
     be designed, as appropriate, to take into account different 
     characteristics of treatment modalities that may affect 
     research outcomes, such as the phase of the treatment 
     modality in the innovation cycle and the impact of the skill 
     of the operator of the treatment modality.
       ``(3) Data collection.--
       ``(A) In general.--The Secretary shall, with appropriate 
     safeguards for privacy, make available to the Institute such 
     data collected by the Centers for Medicare & Medicaid 
     Services, as well as provide access to the data networks, as 
     the Institute and its contractors may require to carry out 
     this section. The Institute may also request and obtain data 
     from Federal, State, or private entities, including data from 
     clinical databases and registries.
       ``(B) Use of data.--The Institute shall only use data 
     provided to the Institute under subparagraph (A) in 
     accordance with laws and regulations governing the release 
     and use of such data, including applicable confidentiality 
     and privacy standards.
       ``(4) Appointing expert advisory panels.--
       ``(A) Appointment.--
       ``(i) In general.--The Institute may appoint permanent or 
     ad hoc expert advisory panels as determined appropriate to 
     assist in identifying research priorities and establishing 
     the research project agenda under paragraph (1) and for other 
     purposes.
       ``(ii) Expert advisory panels for clinical trials.--The 
     Institute shall appoint expert advisory panels in carrying 
     out randomized clinical trials under the research project 
     agenda under paragraph (2)(A)(ii). Such expert advisory 
     panels shall advise the Institute and the agency, 
     instrumentality, or entity conducting the research on the 
     research question involved and the research design or 
     protocol, including important patient subgroups and other 
     parameters of the research. Such panels shall be available as 
     a resource for technical questions that may arise during the 
     conduct of such research.
       ``(iii) Expert advisory panel for rare disease.--In the 
     case of a research study for rare disease, the Institute 
     shall appoint an expert advisory panel for purposes of 
     assisting in the design of the research study and determining 
     the relative value and feasibility of conducting the research 
     study.
       ``(B) Composition.--An expert advisory panel appointed 
     under subparagraph (A) shall include representatives of 
     practicing and research clinicians, patients, and experts in 
     scientific and health services research, health services 
     delivery, and evidence-based medicine who have experience in 
     the relevant topic, and as appropriate, experts in 
     integrative health and primary prevention strategies. The 
     Institute may include a technical expert of each manufacturer 
     or each medical technology that is included under the 
     relevant topic, project, or category for which the panel is 
     established.
       ``(5) Supporting patient and consumer representatives.--The 
     Institute shall provide support and resources to help patient 
     and consumer representatives effectively participate on the 
     Board and expert advisory panels appointed by the Institute 
     under paragraph (4).
       ``(6) Establishing methodology committee.--
       ``(A) In general.--The Institute shall establish a standing 
     methodology committee to carry out the functions described in 
     subparagraph (C).
       ``(B) Appointment and composition.--The methodology 
     committee established under subparagraph (A) shall be 
     composed of not more than 15 members appointed by the 
     Comptroller General of the United States. Members appointed 
     to the methodology committee shall be experts in their 
     scientific field, such as health services research, clinical 
     research, comparative clinical effectiveness research, 
     biostatistics, genomics, and research methodologies. 
     Stakeholders with such expertise may be appointed to the 
     methodology committee. In addition to the members appointed 
     under the first sentence, the Directors of the National 
     Institutes of Health and the Agency for Healthcare Research 
     and Quality (or their designees) shall each be included as 
     members of the methodology committee.
       ``(C) Functions.--Subject to subparagraph (D), the 
     methodology committee shall work to develop and improve the 
     science and methods of comparative clinical effectiveness 
     research by, not later than 18 months after the establishment 
     of the Institute, directly or through subcontract, developing 
     and periodically updating the following:
       ``(i) Methodological standards for research. Such 
     methodological standards shall provide specific criteria for 
     internal validity, generalizability, feasibility, and 
     timeliness of research and for health outcomes measures, risk 
     adjustment, and other relevant aspects of research and 
     assessment with respect to

[[Page S12237]]

     the design of research. Any methodological standards 
     developed and updated under this subclause shall be 
     scientifically based and include methods by which new 
     information, data, or advances in technology are considered 
     and incorporated into ongoing research projects by the 
     Institute, as appropriate. The process for developing and 
     updating such standards shall include input from relevant 
     experts, stakeholders, and decisionmakers, and shall provide 
     opportunities for public comment. Such standards shall also 
     include methods by which patient subpopulations can be 
     accounted for and evaluated in different types of research. 
     As appropriate, such standards shall build on existing work 
     on methodological standards for defined categories of health 
     interventions and for each of the major categories of 
     comparative clinical effectiveness research methods 
     (determined as of the date of enactment of the Patient 
     Protection and Affordable Care Act).
       ``(ii) A translation table that is designed to provide 
     guidance and act as a reference for the Board to determine 
     research methods that are most likely to address each 
     specific research question.
       ``(D) Consultation and conduct of examinations.--The 
     methodology committee may consult and contract with the 
     Institute of Medicine of the National Academies and academic, 
     nonprofit, or other private and governmental entities with 
     relevant expertise to carry out activities described in 
     subparagraph (C) and may consult with relevant stakeholders 
     to carry out such activities.
       ``(E) Reports.--The methodology committee shall submit 
     reports to the Board on the committee's performance of the 
     functions described in subparagraph (C). Reports shall 
     contain recommendations for the Institute to adopt 
     methodological standards developed and updated by the 
     methodology committee as well as other actions deemed 
     necessary to comply with such methodological standards.
       ``(7) Providing for a peer-review process for primary 
     research.--
       ``(A) In general.--The Institute shall ensure that there is 
     a process for peer review of primary research described in 
     subparagraph (A)(ii) of paragraph (2) that is conducted under 
     such paragraph. Under such process--
       ``(i) evidence from such primary research shall be reviewed 
     to assess scientific integrity and adherence to 
     methodological standards adopted under paragraph (9); and
       ``(ii) a list of the names of individuals contributing to 
     any peer-review process during the preceding year or years 
     shall be made public and included in annual reports in 
     accordance with paragraph (10)(D).
       ``(B) Composition.--Such peer-review process shall be 
     designed in a manner so as to avoid bias and conflicts of 
     interest on the part of the reviewers and shall be composed 
     of experts in the scientific field relevant to the research 
     under review.
       ``(C) Use of existing processes.--
       ``(i) Processes of another entity.--In the case where the 
     Institute enters into a contract or other agreement with 
     another entity for the conduct or management of research 
     under this section, the Institute may utilize the peer-review 
     process of such entity if such process meets the requirements 
     under subparagraphs (A) and (B).
       ``(ii) Processes of appropriate medical journals.--The 
     Institute may utilize the peer-review process of appropriate 
     medical journals if such process meets the requirements under 
     subparagraphs (A) and (B).
       ``(8) Release of research findings.--
       ``(A) In general.--The Institute shall, not later than 90 
     days after the conduct or receipt of research findings under 
     this part, make such research findings available to 
     clinicians, patients, and the general public. The Institute 
     shall ensure that the research findings--
       ``(i) convey the findings of research in a manner that is 
     comprehensible and useful to patients and providers in making 
     health care decisions;
       ``(ii) fully convey findings and discuss considerations 
     specific to certain subpopulations, risk factors, and 
     comorbidities, as appropriate;
       ``(iii) include limitations of the research and what 
     further research may be needed as appropriate;
       ``(iv) not be construed as mandates for practice 
     guidelines, coverage recommendations, payment, or policy 
     recommendations; and
       ``(v) not include any data which would violate the privacy 
     of research participants or any confidentiality agreements 
     made with respect to the use of data under this section.
       ``(B) Definition of research findings.--In this paragraph, 
     the term `research findings' means the results of a study or 
     assessment.
       ``(9) Adoption.--Subject to subsection (h)(1), the 
     Institute shall adopt the national priorities identified 
     under paragraph (1)(A), the research project agenda 
     established under paragraph (1)(B), the methodological 
     standards developed and updated by the methodology committee 
     under paragraph (6)(C)(i), and any peer-review process 
     provided under paragraph (7) by majority vote. In the case 
     where the Institute does not adopt such processes in 
     accordance with the preceding sentence, the processes shall 
     be referred to the appropriate staff or entity within the 
     Institute (or, in the case of the methodological standards, 
     the methodology committee) for further review.
       ``(10) Annual reports.--The Institute shall submit an 
     annual report to Congress and the President, and shall make 
     the annual report available to the public. Such report shall 
     contain--
       ``(A) a description of the activities conducted under this 
     section, research priorities identified under paragraph 
     (1)(A) and methodological standards developed and updated by 
     the methodology committee under paragraph (6)(C)(i) that are 
     adopted under paragraph (9) during the preceding year;
       ``(B) the research project agenda and budget of the 
     Institute for the following year;
       ``(C) any administrative activities conducted by the 
     Institute during the preceding year;
       ``(D) the names of individuals contributing to any peer-
     review process under paragraph (7), without identifying them 
     with a particular research project; and
       ``(E) any other relevant information (including information 
     on the membership of the Board, expert advisory panels, 
     methodology committee, and the executive staff of the 
     Institute, any conflicts of interest with respect to these 
     individuals, and any bylaws adopted by the Board during the 
     preceding year).
       ``(e) Administration.--
       ``(1) In general.--Subject to paragraph (2), the Board 
     shall carry out the duties of the Institute.
       ``(2) Nondelegable duties.--The activities described in 
     subsections (d)(1) and (d)(9) are nondelegable.
       ``(f) Board of Governors.--
       ``(1) In general.--The Institute shall have a Board of 
     Governors, which shall consist of the following members:
       ``(A) The Director of Agency for Healthcare Research and 
     Quality (or the Director's designee).
       ``(B) The Director of the National Institutes of Health (or 
     the Director's designee).
       ``(C) Fourteen members appointed, not later than 6 months 
     after the date of enactment of this section, by the 
     Comptroller General of the United States as follows:
       ``(i) 3 members representing patients and health care 
     consumers.
       ``(ii) 5 members representing physicians and providers, 
     including at least 1 surgeon, nurse, State-licensed 
     integrative health care practitioner, and representative of a 
     hospital.
       ``(iii) 3 members representing pharmaceutical, device, and 
     diagnostic manufacturers or developers.
       ``(iv) 1 member representing quality improvement or 
     independent health service researchers.
       ``(v) 2 members representing the Federal Government or the 
     States, including at least 1 member representing a Federal 
     health program or agency.
       ``(2) Qualifications.--The Board shall represent a broad 
     range of perspectives and collectively have scientific 
     expertise in clinical health sciences research, including 
     epidemiology, decisions sciences, health economics, and 
     statistics. In appointing the Board, the Comptroller General 
     of the United States shall consider and disclose any 
     conflicts of interest in accordance with subsection 
     (h)(4)(B). Members of the Board shall be recused from 
     relevant Institute activities in the case where the member 
     (or an immediate family member of such member) has a real 
     conflict of interest directly related to the research project 
     or the matter that could affect or be affected by such 
     participation.
       ``(3) Terms; vacancies.--A member of the Board shall be 
     appointed for a term of 6 years, except with respect to the 
     members first appointed, whose terms of appointment shall be 
     staggered evenly over 2-year increments. No individual shall 
     be appointed to the Board for more than 2 terms. Vacancies 
     shall be filled in the same manner as the original 
     appointment was made.
       ``(4) Chairperson and vice-chairperson.--The Comptroller 
     General of the United States shall designate a Chairperson 
     and Vice Chairperson of the Board from among the members of 
     the Board. Such members shall serve as Chairperson or Vice 
     Chairperson for a period of 3 years.
       ``(5) Compensation.--Each member of the Board who is not an 
     officer or employee of the Federal Government shall be 
     entitled to compensation (equivalent to the rate provided for 
     level IV of the Executive Schedule under section 5315 of 
     title 5, United States Code) and expenses incurred while 
     performing the duties of the Board. An officer or employee of 
     the Federal government who is a member of the Board shall be 
     exempt from compensation.
       ``(6) Director and staff; experts and consultants.--The 
     Board may employ and fix the compensation of an Executive 
     Director and such other personnel as may be necessary to 
     carry out the duties of the Institute and may seek such 
     assistance and support of, or contract with, experts and 
     consultants that may be necessary for the performance of the 
     duties of the Institute.
       ``(7) Meetings and hearings.--The Board shall meet and hold 
     hearings at the call of the Chairperson or a majority of its 
     members. Meetings not solely concerning matters of personnel 
     shall be advertised at least 7 days in advance and open to 
     the public. A majority of the Board members shall constitute 
     a quorum, but a lesser number of members may meet and hold 
     hearings.
       ``(g) Financial and Governmental Oversight.--
       ``(1) Contract for audit.--The Institute shall provide for 
     the conduct of financial audits of the Institute on an annual 
     basis by a private entity with expertise in conducting 
     financial audits.
       ``(2) Review and annual reports.--

[[Page S12238]]

       ``(A) Review.--The Comptroller General of the United States 
     shall review the following:
       ``(i) Not less frequently than on an annual basis, the 
     financial audits conducted under paragraph (1).
       ``(ii) Not less frequently than every 5 years, the 
     processes established by the Institute, including the 
     research priorities and the conduct of research projects, in 
     order to determine whether information produced by such 
     research projects is objective and credible, is produced in a 
     manner consistent with the requirements under this section, 
     and is developed through a transparent process.
       ``(B) Annual reports.--Not later than April 1 of each year, 
     the Comptroller General of the United States shall submit to 
     Congress a report containing the results of the review 
     conducted under subparagraph (A) with respect to the 
     preceding year (or years, if applicable), together with 
     recommendations for such legislation and administrative 
     action as the Comptroller General determines appropriate.
       ``(h) Ensuring Transparency, Credibility, and Access.--The 
     Institute shall establish procedures to ensure that the 
     following requirements for ensuring transparency, 
     credibility, and access are met:
       ``(1) Public comment periods.--The Institute shall provide 
     for a public comment period of not less than 45 days and not 
     more than 60 days prior to the adoption under subsection 
     (d)(9) of the national priorities identified under subsection 
     (d)(1)(A), the research project agenda established under 
     subsection (d)(1)(B), the methodological standards developed 
     and updated by the methodology committee under subsection 
     (d)(6)(C)(i), and the peer-review process provided under 
     paragraph (7), and after the release of draft findings with 
     respect to systematic reviews of existing research and 
     evidence.
       ``(2) Additional forums.--The Institute shall support 
     forums to increase public awareness and obtain and 
     incorporate public input and feedback through media (such as 
     an Internet website) on research priorities, research 
     findings, and other duties, activities, or processes the 
     Institute determines appropriate.
       ``(3) Public availability.--The Institute shall make 
     available to the public and disclose through the official 
     public Internet website of the Institute the following:
       ``(A) Information contained in research findings as 
     specified in subsection (d)(9).
       ``(B) The process and methods for the conduct of research, 
     including the identity of the entity and the investigators 
     conducing such research and any conflicts of interests of 
     such parties, any direct or indirect links the entity has to 
     industry, and research protocols, including measures taken, 
     methods of research and analysis, research results, and such 
     other information the Institute determines appropriate) 
     concurrent with the release of research findings.
       ``(C) Notice of public comment periods under paragraph (1), 
     including deadlines for public comments.
       ``(D) Subsequent comments received during each of the 
     public comment periods.
       ``(E) In accordance with applicable laws and processes and 
     as the Institute determines appropriate, proceedings of the 
     Institute.
       ``(4) Disclosure of conflicts of interest.--
       ``(A) In general.--A conflict of interest shall be 
     disclosed in the following manner:
       ``(i) By the Institute in appointing members to an expert 
     advisory panel under subsection (d)(4), in selecting 
     individuals to contribute to any peer-review process under 
     subsection (d)(7), and for employment as executive staff of 
     the Institute.
       ``(ii) By the Comptroller General in appointing members of 
     the methodology committee under subsection (d)(6);
       ``(iii) By the Institute in the annual report under 
     subsection (d)(10), except that, in the case of individuals 
     contributing to any such peer review process, such 
     description shall be in a manner such that those individuals 
     cannot be identified with a particular research project.
       ``(B) Manner of disclosure.--Conflicts of interest shall be 
     disclosed as described in subparagraph (A) as soon as 
     practicable on the Internet web site of the Institute and of 
     the Government Accountability Office. The information 
     disclosed under the preceding sentence shall include the 
     type, nature, and magnitude of the interests of the 
     individual involved, except to the extent that the individual 
     recuses himself or herself from participating in the 
     consideration of or any other activity with respect to the 
     study as to which the potential conflict exists.
       ``(i) Rules.--The Institute, its Board or staff, shall be 
     prohibited from accepting gifts, bequeaths, or donations of 
     services or property. In addition, the Institute shall be 
     prohibited from establishing a corporation or generating 
     revenues from activities other than as provided under this 
     section.

                     Subtitle F--Elder Justice Act

     SEC. 5401. SHORT TITLE OF SUBTITLE.

       This subtitle may be cited as the ``Elder Justice Act of 
     2009''.

     SEC. 5402. DEFINITIONS.

       Except as otherwise specifically provided, any term that is 
     defined in section 2011 of the Social Security Act (as added 
     by section 5503(a)) and is used in this subtitle has the 
     meaning given such term by such section.

     SEC. 5403. ELDER JUSTICE.

       (a) Elder Justice.--
       (1) In general.--Title XX of the Social Security Act (42 
     U.S.C. 1397 et seq.) is amended--
       (A) in the heading, by inserting ``AND ELDER JUSTICE'' 
     after ``SOCIAL SERVICES'';
       (B) by inserting before section 2001 the following:

      ``Subtitle A--Block Grants to States for Social Services'';

     and
       (C) by adding at the end the following:

                      ``Subtitle B--Elder Justice

     ``SEC. 2011. DEFINITIONS.

       ``In this subtitle:
       ``(1) Abuse.--The term `abuse' means the knowing infliction 
     of physical or psychological harm or the knowing deprivation 
     of goods or services that are necessary to meet essential 
     needs or to avoid physical or psychological harm.
       ``(2) Adult protective services.--The term `adult 
     protective services' means such services provided to adults 
     as the Secretary may specify and includes services such as--
       ``(A) receiving reports of adult abuse, neglect, or 
     exploitation;
       ``(B) investigating the reports described in subparagraph 
     (A);
       ``(C) case planning, monitoring, evaluation, and other case 
     work and services; and
       ``(D) providing, arranging for, or facilitating the 
     provision of medical, social service, economic, legal, 
     housing, law enforcement, or other protective, emergency, or 
     support services.
       ``(3) Caregiver.--The term `caregiver' means an individual 
     who has the responsibility for the care of an elder, either 
     voluntarily, by contract, by receipt of payment for care, or 
     as a result of the operation of law, and means a family 
     member or other individual who provides (on behalf of such 
     individual or of a public or private agency, organization, or 
     institution) compensated or uncompensated care to an elder 
     who needs supportive services in any setting.
       ``(4) Direct care.--The term `direct care' means care by an 
     employee or contractor who provides assistance or long-term 
     care services to a recipient.
       ``(5) Elder.--The term `elder' means an individual age 60 
     or older.
       ``(6) Elder justice.--The term `elder justice' means--
       ``(A) from a societal perspective, efforts to--
       ``(i) prevent, detect, treat, intervene in, and prosecute 
     elder abuse, neglect, and exploitation; and
       ``(ii) protect elders with diminished capacity while 
     maximizing their autonomy; and
       ``(B) from an individual perspective, the recognition of an 
     elder's rights, including the right to be free of abuse, 
     neglect, and exploitation.
       ``(7) Eligible entity.--The term `eligible entity' means a 
     State or local government agency, Indian tribe or tribal 
     organization, or any other public or private entity that is 
     engaged in and has expertise in issues relating to elder 
     justice or in a field necessary to promote elder justice 
     efforts.
       ``(8) Exploitation.--The term `exploitation' means the 
     fraudulent or otherwise illegal, unauthorized, or improper 
     act or process of an individual, including a caregiver or 
     fiduciary, that uses the resources of an elder for monetary 
     or personal benefit, profit, or gain, or that results in 
     depriving an elder of rightful access to, or use of, 
     benefits, resources, belongings, or assets.
       ``(9) Fiduciary.--The term `fiduciary'--
       ``(A) means a person or entity with the legal 
     responsibility--
       ``(i) to make decisions on behalf of and for the benefit of 
     another person; and
       ``(ii) to act in good faith and with fairness; and
       ``(B) includes a trustee, a guardian, a conservator, an 
     executor, an agent under a financial power of attorney or 
     health care power of attorney, or a representative payee.
       ``(10) Grant.--The term `grant' includes a contract, 
     cooperative agreement, or other mechanism for providing 
     financial assistance.
       ``(11) Guardianship.--The term `guardianship' means--
       ``(A) the process by which a State court determines that an 
     adult individual lacks capacity to make decisions about self-
     care or property, and appoints another individual or entity 
     known as a guardian, as a conservator, or by a similar term, 
     as a surrogate decisionmaker;
       ``(B) the manner in which the court-appointed surrogate 
     decisionmaker carries out duties to the individual and the 
     court; or
       ``(C) the manner in which the court exercises oversight of 
     the surrogate decisionmaker.
       ``(12) Indian tribe.--
       ``(A) In general.--The term `Indian tribe' has the meaning 
     given such term in section 4 of the Indian Self-Determination 
     and Education Assistance Act (25 U.S.C. 450b).
       ``(B) Inclusion of pueblo and rancheria.--The term `Indian 
     tribe' includes any Pueblo or Rancheria.
       ``(13) Law enforcement.--The term `law enforcement' means 
     the full range of potential responders to elder abuse, 
     neglect, and exploitation including--
       ``(A) police, sheriffs, detectives, public safety officers, 
     and corrections personnel;
       ``(B) prosecutors;
       ``(C) medical examiners;
       ``(D) investigators; and
       ``(E) coroners.
       ``(14) Long-term care.--

[[Page S12239]]

       ``(A) In general.--The term `long-term care' means 
     supportive and health services specified by the Secretary for 
     individuals who need assistance because the individuals have 
     a loss of capacity for self-care due to illness, disability, 
     or vulnerability.
       ``(B) Loss of capacity for self-care.--For purposes of 
     subparagraph (A), the term `loss of capacity for self-care' 
     means an inability to engage in 1 or more activities of daily 
     living, including eating, dressing, bathing, management of 
     one's financial affairs, and other activities the Secretary 
     determines appropriate.
       ``(15) Long-term care facility.--The term `long-term care 
     facility' means a residential care provider that arranges 
     for, or directly provides, long-term care.
       ``(16) Neglect.--The term `neglect' means--
       ``(A) the failure of a caregiver or fiduciary to provide 
     the goods or services that are necessary to maintain the 
     health or safety of an elder; or
       ``(B) self-neglect.
       ``(17) Nursing facility.--
       ``(A) In general.--The term `nursing facility' has the 
     meaning given such term under section 1919(a).
       ``(B) Inclusion of skilled nursing facility.--The term 
     `nursing facility' includes a skilled nursing facility (as 
     defined in section 1819(a)).
       ``(18) Self-neglect.--The term `self-neglect' means an 
     adult's inability, due to physical or mental impairment or 
     diminished capacity, to perform essential self-care tasks 
     including--
       ``(A) obtaining essential food, clothing, shelter, and 
     medical care;
       ``(B) obtaining goods and services necessary to maintain 
     physical health, mental health, or general safety; or
       ``(C) managing one's own financial affairs.
       ``(19) Serious bodily injury.--
       ``(A) In general.--The term `serious bodily injury' means 
     an injury--
       ``(i) involving extreme physical pain;
       ``(ii) involving substantial risk of death;
       ``(iii) involving protracted loss or impairment of the 
     function of a bodily member, organ, or mental faculty; or
       ``(iv) requiring medical intervention such as surgery, 
     hospitalization, or physical rehabilitation.
       ``(B) Criminal sexual abuse.--Serious bodily injury shall 
     be considered to have occurred if the conduct causing the 
     injury is conduct described in section 2241 (relating to 
     aggravated sexual abuse) or 2242 (relating to sexual abuse) 
     of title 18, United States Code, or any similar offense under 
     State law.
       ``(20) Social.--The term `social', when used with respect 
     to a service, includes adult protective services.
       ``(21) State legal assistance developer.--The term `State 
     legal assistance developer' means an individual described in 
     section 731 of the Older Americans Act of 1965.
       ``(22) State long-term care ombudsman.--The term `State 
     Long-Term Care Ombudsman' means the State Long-Term Care 
     Ombudsman described in section 712(a)(2) of the Older 
     Americans Act of 1965.

     ``SEC. 2012. GENERAL PROVISIONS.

       ``(a) Protection of Privacy.--In pursuing activities under 
     this subtitle, the Secretary shall ensure the protection of 
     individual health privacy consistent with the regulations 
     promulgated under section 264(c) of the Health Insurance 
     Portability and Accountability Act of 1996 and applicable 
     State and local privacy regulations.
       ``(b) Rule of Construction.--Nothing in this subtitle shall 
     be construed to interfere with or abridge an elder's right to 
     practice his or her religion through reliance on prayer alone 
     for healing when this choice--
       ``(1) is contemporaneously expressed, either orally or in 
     writing, with respect to a specific illness or injury which 
     the elder has at the time of the decision by an elder who is 
     competent at the time of the decision;
       ``(2) is previously set forth in a living will, health care 
     proxy, or other advance directive document that is validly 
     executed and applied under State law; or
       ``(3) may be unambiguously deduced from the elder's life 
     history.

    ``PART I--NATIONAL COORDINATION OF ELDER JUSTICE ACTIVITIES AND 
                                RESEARCH

 ``Subpart A--Elder Justice Coordinating Council and Advisory Board on 
                 Elder Abuse, Neglect, and Exploitation

     ``SEC. 2021. ELDER JUSTICE COORDINATING COUNCIL.

       ``(a) Establishment.--There is established within the 
     Office of the Secretary an Elder Justice Coordinating Council 
     (in this section referred to as the `Council').
       ``(b) Membership.--
       ``(1) In general.--The Council shall be composed of the 
     following members:
       ``(A) The Secretary (or the Secretary's designee).
       ``(B) The Attorney General (or the Attorney General's 
     designee).
       ``(C) The head of each Federal department or agency or 
     other governmental entity identified by the Chair referred to 
     in subsection (d) as having responsibilities, or 
     administering programs, relating to elder abuse, neglect, and 
     exploitation.
       ``(2) Requirement.--Each member of the Council shall be an 
     officer or employee of the Federal Government.
       ``(c) Vacancies.--Any vacancy in the Council shall not 
     affect its powers, but shall be filled in the same manner as 
     the original appointment was made.
       ``(d) Chair.--The member described in subsection (b)(1)(A) 
     shall be Chair of the Council.
       ``(e) Meetings.--The Council shall meet at least 2 times 
     per year, as determined by the Chair.
       ``(f) Duties.--
       ``(1) In general.--The Council shall make recommendations 
     to the Secretary for the coordination of activities of the 
     Department of Health and Human Services, the Department of 
     Justice, and other relevant Federal, State, local, and 
     private agencies and entities, relating to elder abuse, 
     neglect, and exploitation and other crimes against elders.
       ``(2) Report.--Not later than the date that is 2 years 
     after the date of enactment of the Elder Justice Act of 2009 
     and every 2 years thereafter, the Council shall submit to 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 that--
       ``(A) describes the activities and accomplishments of, and 
     challenges faced by--
       ``(i) the Council; and
       ``(ii) the entities represented on the Council; and
       ``(B) makes such recommendations for legislation, model 
     laws, or other action as the Council determines to be 
     appropriate.
       ``(g) Powers of the Council.--
       ``(1) Information from federal agencies.--Subject to the 
     requirements of section 2012(a), the Council may secure 
     directly from any Federal department or agency such 
     information as the Council considers necessary to carry out 
     this section. Upon request of the Chair of the Council, the 
     head of such department or agency shall furnish such 
     information to the Council.
       ``(2) Postal services.--The Council may use the United 
     States mails in the same manner and under the same conditions 
     as other departments and agencies of the Federal Government.
       ``(h) Travel Expenses.--The members of the Council shall 
     not receive compensation for the performance of services for 
     the Council. The members shall be allowed travel expenses, 
     including per diem in lieu of subsistence, at rates 
     authorized for employees of agencies under subchapter I of 
     chapter 57 of title 5, United States Code, while away from 
     their homes or regular places of business in the performance 
     of services for the Council. Notwithstanding section 1342 of 
     title 31, United States Code, the Secretary may accept the 
     voluntary and uncompensated services of the members of the 
     Council.
       ``(i) Detail of Government Employees.--Any Federal 
     Government employee may be detailed to the Council without 
     reimbursement, and such detail shall be without interruption 
     or loss of civil service status or privilege.
       ``(j) Status as Permanent Council.--Section 14 of the 
     Federal Advisory Committee Act (5 U.S.C. App.) shall not 
     apply to the Council.
       ``(k) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as are necessary to 
     carry out this section.

     ``SEC. 2022. ADVISORY BOARD ON ELDER ABUSE, NEGLECT, AND 
                   EXPLOITATION.

       ``(a) Establishment.--There is established a board to be 
     known as the `Advisory Board on Elder Abuse, Neglect, and 
     Exploitation' (in this section referred to as the `Advisory 
     Board') to create short- and long-term multidisciplinary 
     strategic plans for the development of the field of elder 
     justice and to make recommendations to the Elder Justice 
     Coordinating Council established under section 2021.
       ``(b) Composition.--The Advisory Board shall be composed of 
     27 members appointed by the Secretary from among members of 
     the general public who are individuals with experience and 
     expertise in elder abuse, neglect, and exploitation 
     prevention, detection, treatment, intervention, or 
     prosecution.
       ``(c) Solicitation of Nominations.--The Secretary shall 
     publish a notice in the Federal Register soliciting 
     nominations for the appointment of members of the Advisory 
     Board under subsection (b).
       ``(d) Terms.--
       ``(1) In general.--Each member of the Advisory Board shall 
     be appointed for a term of 3 years, except that, of the 
     members first appointed--
       ``(A) 9 shall be appointed for a term of 3 years;
       ``(B) 9 shall be appointed for a term of 2 years; and
       ``(C) 9 shall be appointed for a term of 1 year.
       ``(2) Vacancies.--
       ``(A) In general.--Any vacancy on the Advisory Board shall 
     not affect its powers, but shall be filled in the same manner 
     as the original appointment was made.
       ``(B) Filling unexpired term.--An individual chosen to fill 
     a vacancy shall be appointed for the unexpired term of the 
     member replaced.
       ``(3) Expiration of terms.--The term of any member shall 
     not expire before the date on which the member's successor 
     takes office.
       ``(e) Election of Officers.--The Advisory Board shall elect 
     a Chair and Vice Chair from among its members. The Advisory 
     Board shall elect its initial Chair and Vice Chair at its 
     initial meeting.
       ``(f) Duties.--
       ``(1) Enhance communication on promoting quality of, and 
     preventing abuse, neglect,

[[Page S12240]]

     and exploitation in, long-term care.--The Advisory Board 
     shall develop collaborative and innovative approaches to 
     improve the quality of, including preventing abuse, neglect, 
     and exploitation in, long-term care.
       ``(2) Collaborative efforts to develop consensus around the 
     management of certain quality-related factors.--
       ``(A) In general.--The Advisory Board shall establish 
     multidisciplinary panels to address, and develop consensus 
     on, subjects relating to improving the quality of long-term 
     care. At least 1 such panel shall address, and develop 
     consensus on, methods for managing resident-to-resident abuse 
     in long-term care.
       ``(B) Activities conducted.--The multidisciplinary panels 
     established under subparagraph (A) shall examine relevant 
     research and data, identify best practices with respect to 
     the subject of the panel, determine the best way to carry out 
     those best practices in a practical and feasible manner, and 
     determine an effective manner of distributing information on 
     such subject.
       ``(3) Report.--Not later than the date that is 18 months 
     after the date of enactment of the Elder Justice Act of 2009, 
     and annually thereafter, the Advisory Board shall prepare and 
     submit to the Elder Justice Coordinating Council, 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 containing--
       ``(A) information on the status of Federal, State, and 
     local public and private elder justice activities;
       ``(B) recommendations (including recommended priorities) 
     regarding--
       ``(i) elder justice programs, research, training, services, 
     practice, enforcement, and coordination;
       ``(ii) coordination between entities pursuing elder justice 
     efforts and those involved in related areas that may inform 
     or overlap with elder justice efforts, such as activities to 
     combat violence against women and child abuse and neglect; 
     and
       ``(iii) activities relating to adult fiduciary systems, 
     including guardianship and other fiduciary arrangements;
       ``(C) recommendations for specific modifications needed in 
     Federal and State laws (including regulations) or for 
     programs, research, and training to enhance prevention, 
     detection, and treatment (including diagnosis) of, 
     intervention in (including investigation of), and prosecution 
     of elder abuse, neglect, and exploitation;
       ``(D) recommendations on methods for the most effective 
     coordinated national data collection with respect to elder 
     justice, and elder abuse, neglect, and exploitation; and
       ``(E) recommendations for a multidisciplinary strategic 
     plan to guide the effective and efficient development of the 
     field of elder justice.
       ``(g) Powers of the Advisory Board.--
       ``(1) Information from federal agencies.--Subject to the 
     requirements of section 2012(a), the Advisory Board may 
     secure directly from any Federal department or agency such 
     information as the Advisory Board considers necessary to 
     carry out this section. Upon request of the Chair of the 
     Advisory Board, the head of such department or agency shall 
     furnish such information to the Advisory Board.
       ``(2) Sharing of data and reports.--The Advisory Board may 
     request from any entity pursuing elder justice activities 
     under the Elder Justice Act of 2009 or an amendment made by 
     that Act, any data, reports, or recommendations generated in 
     connection with such activities.
       ``(3) Postal services.--The Advisory Board may use the 
     United States mails in the same manner and under the same 
     conditions as other departments and agencies of the Federal 
     Government.
       ``(h) Travel Expenses.--The members of the Advisory Board 
     shall not receive compensation for the performance of 
     services for the Advisory Board. The members shall be allowed 
     travel expenses for up to 4 meetings per year, including per 
     diem in lieu of subsistence, at rates authorized for 
     employees of agencies under subchapter I of chapter 57 of 
     title 5, United States Code, while away from their homes or 
     regular places of business in the performance of services for 
     the Advisory Board. Notwithstanding section 1342 of title 31, 
     United States Code, the Secretary may accept the voluntary 
     and uncompensated services of the members of the Advisory 
     Board.
       ``(i) Detail of Government Employees.--Any Federal 
     Government employee may be detailed to the Advisory Board 
     without reimbursement, and such detail shall be without 
     interruption or loss of civil service status or privilege.
       ``(j) Status as Permanent Advisory Committee.--Section 14 
     of the Federal Advisory Committee Act (5 U.S.C. App.) shall 
     not apply to the advisory board.
       ``(k) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as are necessary to 
     carry out this section.

     ``SEC. 2023. RESEARCH PROTECTIONS.

       ``(a) Guidelines.--The Secretary shall promulgate 
     guidelines to assist researchers working in the area of elder 
     abuse, neglect, and exploitation, with issues relating to 
     human subject protections.
       ``(b) Definition of Legally Authorized Representative for 
     Application of Regulations.--For purposes of the application 
     of subpart A of part 46 of title 45, Code of Federal 
     Regulations, to research conducted under this subpart, the 
     term `legally authorized representative' means, unless 
     otherwise provided by law, the individual or judicial or 
     other body authorized under the applicable law to consent to 
     medical treatment on behalf of another person.

     ``SEC. 2024. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated to carry out this 
     subpart--
       ``(1) for fiscal year 2011, $6,500,000; and
       ``(2) for each of fiscal years 2012 through 2014, 
     $7,000,000.

  ``Subpart B--Elder Abuse, Neglect, and Exploitation Forensic Centers

     ``SEC. 2031. ESTABLISHMENT AND SUPPORT OF ELDER ABUSE, 
                   NEGLECT, AND EXPLOITATION FORENSIC CENTERS.

       ``(a) In General.--The Secretary, in consultation with the 
     Attorney General, shall make grants to eligible entities to 
     establish and operate stationary and mobile forensic centers, 
     to develop forensic expertise regarding, and provide services 
     relating to, elder abuse, neglect, and exploitation.
       ``(b) Stationary Forensic Centers.--The Secretary shall 
     make 4 of the grants described in subsection (a) to 
     institutions of higher education with demonstrated expertise 
     in forensics or commitment to preventing or treating elder 
     abuse, neglect, or exploitation, to establish and operate 
     stationary forensic centers.
       ``(c) Mobile Centers.--The Secretary shall make 6 of the 
     grants described in subsection (a) to appropriate entities to 
     establish and operate mobile forensic centers.
       ``(d) Authorized Activities.--
       ``(1) Development of forensic markers and methodologies.--
     An eligible entity that receives a grant under this section 
     shall use funds made available through the grant to assist in 
     determining whether abuse, neglect, or exploitation occurred 
     and whether a crime was committed and to conduct research to 
     describe and disseminate information on--
       ``(A) forensic markers that indicate a case in which elder 
     abuse, neglect, or exploitation may have occurred; and
       ``(B) methodologies for determining, in such a case, when 
     and how health care, emergency service, social and protective 
     services, and legal service providers should intervene and 
     when the providers should report the case to law enforcement 
     authorities.
       ``(2) Development of forensic expertise.--An eligible 
     entity that receives a grant under this section shall use 
     funds made available through the grant to develop forensic 
     expertise regarding elder abuse, neglect, and exploitation in 
     order to provide medical and forensic evaluation, therapeutic 
     intervention, victim support and advocacy, case review, and 
     case tracking.
       ``(3) Collection of evidence.--The Secretary, in 
     coordination with the Attorney General, shall use data made 
     available by grant recipients under this section to develop 
     the capacity of geriatric health care professionals and law 
     enforcement to collect forensic evidence, including 
     collecting forensic evidence relating to a potential 
     determination of elder abuse, neglect, or exploitation.
       ``(e) Application.--To be eligible to receive a grant under 
     this section, an entity shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section--
       ``(1) for fiscal year 2011, $4,000,000;
       ``(2) for fiscal year 2012, $6,000,000; and
       ``(3) for each of fiscal years 2013 and 2014, $8,000,000.

              ``PART II--PROGRAMS TO PROMOTE ELDER JUSTICE

     ``SEC. 2041. ENHANCEMENT OF LONG-TERM CARE.

       ``(a) Grants and Incentives for Long-Term Care Staffing.--
       ``(1) In general.--The Secretary shall carry out 
     activities, including activities described in paragraphs (2) 
     and (3), to provide incentives for individuals to train for, 
     seek, and maintain employment providing direct care in long-
     term care.
       ``(2) Specific programs to enhance training, recruitment, 
     and retention of staff.--
       ``(A) Coordination with secretary of labor to recruit and 
     train long-term care staff.--The Secretary shall coordinate 
     activities under this subsection with the Secretary of Labor 
     in order to provide incentives for individuals to train for 
     and seek employment providing direct care in long-term care.
       ``(B) Career ladders and wage or benefit increases to 
     increase staffing in long-term care.--
       ``(i) In general.--The Secretary shall make grants to 
     eligible entities to carry out programs through which the 
     entities--

       ``(I) offer, to employees who provide direct care to 
     residents of an eligible entity or individuals receiving 
     community-based long-term care from an eligible entity, 
     continuing training and varying levels of certification, 
     based on observed clinical care practices and the amount of 
     time the employees spend providing direct care; and
       ``(II) provide, or make arrangements to provide, bonuses or 
     other increased compensation or benefits to employees who 
     achieve certification under such a program.

       ``(ii) Application.--To be eligible to receive a grant 
     under this subparagraph, an eligible entity shall submit an 
     application to

[[Page S12241]]

     the Secretary at such time, in such manner, and containing 
     such information as the Secretary may require (which may 
     include evidence of consultation with the State in which the 
     eligible entity is located with respect to carrying out 
     activities funded under the grant).
       ``(iii) Authority to limit number of applicants.--Nothing 
     in this subparagraph shall be construed as prohibiting the 
     Secretary from limiting the number of applicants for a grant 
     under this subparagraph.
       ``(3) Specific programs to improve management practices.--
       ``(A) In general.--The Secretary shall make grants to 
     eligible entities to enable the entities to provide training 
     and technical assistance.
       ``(B) Authorized activities.--An eligible entity that 
     receives a grant under subparagraph (A) shall use funds made 
     available through the grant to provide training and technical 
     assistance regarding management practices using methods that 
     are demonstrated to promote retention of individuals who 
     provide direct care, such as--
       ``(i) the establishment of standard human resource policies 
     that reward high performance, including policies that provide 
     for improved wages and benefits on the basis of job reviews;
       ``(ii) the establishment of motivational and thoughtful 
     work organization practices;
       ``(iii) the creation of a workplace culture that respects 
     and values caregivers and their needs;
       ``(iv) the promotion of a workplace culture that respects 
     the rights of residents of an eligible entity or individuals 
     receiving community-based long-term care from an eligible 
     entity and results in improved care for the residents or the 
     individuals; and
       ``(v) the establishment of other programs that promote the 
     provision of high quality care, such as a continuing 
     education program that provides additional hours of training, 
     including on-the-job training, for employees who are 
     certified nurse aides.
       ``(C) Application.--To be eligible to receive a grant under 
     this paragraph, an eligible entity shall submit an 
     application to the Secretary at such time, in such manner, 
     and containing such information as the Secretary may require 
     (which may include evidence of consultation with the State in 
     which the eligible entity is located with respect to carrying 
     out activities funded under the grant).
       ``(D) Authority to limit number of applicants.--Nothing in 
     this paragraph shall be construed as prohibiting the 
     Secretary from limiting the number of applicants for a grant 
     under this paragraph.
       ``(4) Accountability measures.--The Secretary shall develop 
     accountability measures to ensure that the activities 
     conducted using funds made available under this subsection 
     benefit individuals who provide direct care and increase the 
     stability of the long-term care workforce.
       ``(5) Definitions.--In this subsection:
       ``(A) Community-based long-term care.--The term `community-
     based long-term care' has the meaning given such term by the 
     Secretary.
       ``(B) Eligible entity.--The term `eligible entity' means 
     the following:
       ``(i) A long-term care facility.
       ``(ii) A community-based long-term care entity (as defined 
     by the Secretary).
       ``(b) Certified EHR Technology Grant Program.--
       ``(1) Grants authorized.--The Secretary is authorized to 
     make grants to long-term care facilities for the purpose of 
     assisting such entities in offsetting the costs related to 
     purchasing, leasing, developing, and implementing certified 
     EHR technology (as defined in section 1848(o)(4)) designed to 
     improve patient safety and reduce adverse events and health 
     care complications resulting from medication errors.
       ``(2) Use of grant funds.--Funds provided under grants 
     under this subsection may be used for any of the following:
       ``(A) Purchasing, leasing, and installing computer software 
     and hardware, including handheld computer technologies.
       ``(B) Making improvements to existing computer software and 
     hardware.
       ``(C) Making upgrades and other improvements to existing 
     computer software and hardware to enable e-prescribing.
       ``(D) Providing education and training to eligible long-
     term care facility staff on the use of such technology to 
     implement the electronic transmission of prescription and 
     patient information.
       ``(3) Application.--
       ``(A) In general.--To be eligible to receive a grant under 
     this subsection, a long-term care facility shall submit an 
     application to the Secretary at such time, in such manner, 
     and containing such information as the Secretary may require 
     (which may include evidence of consultation with the State in 
     which the long-term care facility is located with respect to 
     carrying out activities funded under the grant).
       ``(B) Authority to limit number of applicants.--Nothing in 
     this subsection shall be construed as prohibiting the 
     Secretary from limiting the number of applicants for a grant 
     under this subsection.
       ``(4) Accountability measures.--The Secretary shall develop 
     accountability measures to ensure that the activities 
     conducted using funds made available under this subsection 
     help improve patient safety and reduce adverse events and 
     health care complications resulting from medication errors.
       ``(c) Adoption of Standards for Transactions Involving 
     Clinical Data by Long-Term Care Facilities.--
       ``(1) Standards and compatibility.--The Secretary shall 
     adopt electronic standards for the exchange of clinical data 
     by long-term care facilities, including, where available, 
     standards for messaging and nomenclature. Standards adopted 
     by the Secretary under the preceding sentence shall be 
     compatible with standards established under part C of title 
     XI, standards established under subsections (b)(2)(B)(i) and 
     (e)(4) of section 1860D-4, standards adopted under section 
     3004 of the Public Health Service Act, and general health 
     information technology standards.
       ``(2) Electronic submission of data to the secretary.--
       ``(A) In general.--Not later than 10 years after the date 
     of enactment of the Elder Justice Act of 2009, the Secretary 
     shall have procedures in place to accept the optional 
     electronic submission of clinical data by long-term care 
     facilities pursuant to the standards adopted under paragraph 
     (1).
       ``(B) Rule of construction.--Nothing in this subsection 
     shall be construed to require a long-term care facility to 
     submit clinical data electronically to the Secretary.
       ``(3) Regulations.--The Secretary shall promulgate 
     regulations to carry out this subsection. Such regulations 
     shall require a State, as a condition of the receipt of funds 
     under this part, to conduct such data collection and 
     reporting as the Secretary determines are necessary to 
     satisfy the requirements of this subsection.
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section--
       ``(1) for fiscal year 2011, $20,000,000;
       ``(2) for fiscal year 2012, $17,500,000; and
       ``(3) for each of fiscal years 2013 and 2014, $15,000,000.

     ``SEC. 2042. ADULT PROTECTIVE SERVICES FUNCTIONS AND GRANT 
                   PROGRAMS.

       ``(a) Secretarial Responsibilities.--
       ``(1) In general.--The Secretary shall ensure that the 
     Department of Health and Human Services--
       ``(A) provides funding authorized by this part to State and 
     local adult protective services offices that investigate 
     reports of the abuse, neglect, and exploitation of elders;
       ``(B) collects and disseminates data annually relating to 
     the abuse, exploitation, and neglect of elders in 
     coordination with the Department of Justice;
       ``(C) develops and disseminates information on best 
     practices regarding, and provides training on, carrying out 
     adult protective services;
       ``(D) conducts research related to the provision of adult 
     protective services; and
       ``(E) provides technical assistance to States and other 
     entities that provide or fund the provision of adult 
     protective services, including through grants made under 
     subsections (b) and (c).
       ``(2) Authorization of appropriations.--There are 
     authorized to be appropriated to carry out this subsection, 
     $3,000,000 for fiscal year 2011 and $4,000,000 for each of 
     fiscal years 2012 through 2014.
       ``(b) Grants To Enhance the Provision of Adult Protective 
     Services.--
       ``(1) Establishment.--There is established an adult 
     protective services grant program under which the Secretary 
     shall annually award grants to States in the amounts 
     calculated under paragraph (2) for the purposes of enhancing 
     adult protective services provided by States and local units 
     of government.
       ``(2) Amount of payment.--
       ``(A) In general.--Subject to the availability of 
     appropriations and subparagraphs (B) and (C), the amount paid 
     to a State for a fiscal year under the program under this 
     subsection shall equal the amount appropriated for that year 
     to carry out this subsection multiplied by the percentage of 
     the total number of elders who reside in the United States 
     who reside in that State.
       ``(B) Guaranteed minimum payment amount.--
       ``(i) 50 states.--Subject to clause (ii), if the amount 
     determined under subparagraph (A) for a State for a fiscal 
     year is less than 0.75 percent of the amount appropriated for 
     such year, the Secretary shall increase such determined 
     amount so that the total amount paid under this subsection to 
     the State for the year is equal to 0.75 percent of the amount 
     so appropriated.
       ``(ii) Territories.--In the case of a State other than 1 of 
     the 50 States, clause (i) shall be applied as if each 
     reference to `0.75' were a reference to `0.1'.
       ``(C) Pro rata reductions.--The Secretary shall make such 
     pro rata reductions to the amounts described in subparagraph 
     (A) as are necessary to comply with the requirements of 
     subparagraph (B).
       ``(3) Authorized activities.--
       ``(A) Adult protective services.--Funds made available 
     pursuant to this subsection may only be used by States and 
     local units of government to provide adult protective 
     services and may not be used for any other purpose.
       ``(B) Use by agency.--Each State receiving funds pursuant 
     to this subsection shall provide such funds to the agency or 
     unit of State government having legal responsibility for 
     providing adult protective services within the State.
       ``(C) Supplement not supplant.--Each State or local unit of 
     government shall use funds made available pursuant to this 
     subsection to supplement and not supplant other Federal, 
     State, and local public funds

[[Page S12242]]

     expended to provide adult protective services in the State.
       ``(4) State reports.--Each State receiving funds under this 
     subsection shall submit to the Secretary, at such time and in 
     such manner as the Secretary may require, a report on the 
     number of elders served by the grants awarded under this 
     subsection.
       ``(5) Authorization of appropriations.--There are 
     authorized to be appropriated to carry out this subsection, 
     $100,000,000 for each of fiscal years 2011 through 2014.
       ``(c) State Demonstration Programs.--
       ``(1) Establishment.--The Secretary shall award grants to 
     States for the purposes of conducting demonstration programs 
     in accordance with paragraph (2).
       ``(2) Demonstration programs.--Funds made available 
     pursuant to this subsection may be used by States and local 
     units of government to conduct demonstration programs that 
     test--
       ``(A) training modules developed for the purpose of 
     detecting or preventing elder abuse;
       ``(B) methods to detect or prevent financial exploitation 
     of elders;
       ``(C) methods to detect elder abuse;
       ``(D) whether training on elder abuse forensics enhances 
     the detection of elder abuse by employees of the State or 
     local unit of government; or
       ``(E) other matters relating to the detection or prevention 
     of elder abuse.
       ``(3) Application.--To be eligible to receive a grant under 
     this subsection, a State shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(4) State reports.--Each State that receives funds under 
     this subsection shall submit to the Secretary a report at 
     such time, in such manner, and containing such information as 
     the Secretary may require on the results of the demonstration 
     program conducted by the State using funds made available 
     under this subsection.
       ``(5) Authorization of appropriations.--There are 
     authorized to be appropriated to carry out this subsection, 
     $25,000,000 for each of fiscal years 2011 through 2014.

     ``SEC. 2043. LONG-TERM CARE OMBUDSMAN PROGRAM GRANTS AND 
                   TRAINING.

       ``(a) Grants To Support the Long-Term Care Ombudsman 
     Program.--
       ``(1) In general.--The Secretary shall make grants to 
     eligible entities with relevant expertise and experience in 
     abuse and neglect in long-term care facilities or long-term 
     care ombudsman programs and responsibilities, for the purpose 
     of--
       ``(A) improving the capacity of State long-term care 
     ombudsman programs to respond to and resolve complaints about 
     abuse and neglect;
       ``(B) conducting pilot programs with State long-term care 
     ombudsman offices or local ombudsman entities; and
       ``(C) providing support for such State long-term care 
     ombudsman programs and such pilot programs (such as through 
     the establishment of a national long-term care ombudsman 
     resource center).
       ``(2) Authorization of appropriations.--There are 
     authorized to be appropriated to carry out this subsection--
       ``(A) for fiscal year 2011, $5,000,000;
       ``(B) for fiscal year 2012, $7,500,000; and
       ``(C) for each of fiscal years 2013 and 2014, $10,000,000.
       ``(b) Ombudsman Training Programs.--
       ``(1) In general.--The Secretary shall establish programs 
     to provide and improve ombudsman training with respect to 
     elder abuse, neglect, and exploitation for national 
     organizations and State long-term care ombudsman programs.
       ``(2) Authorization of appropriations.--There are 
     authorized to be appropriated to carry out this subsection, 
     for each of fiscal years 2011 through 2014, $10,000,000.

     ``SEC. 2044. PROVISION OF INFORMATION REGARDING, AND 
                   EVALUATIONS OF, ELDER JUSTICE PROGRAMS.

       ``(a) Provision of Information.--To be eligible to receive 
     a grant under this part, an applicant shall agree--
       ``(1) except as provided in paragraph (2), to provide the 
     eligible entity conducting an evaluation under subsection (b) 
     of the activities funded through the grant with such 
     information as the eligible entity may require in order to 
     conduct such evaluation; or
       ``(2) in the case of an applicant for a grant under section 
     2041(b), to provide the Secretary with such information as 
     the Secretary may require to conduct an evaluation or audit 
     under subsection (c).
       ``(b) Use of Eligible Entities To Conduct Evaluations.--
       ``(1) Evaluations required.--Except as provided in 
     paragraph (2), the Secretary shall--
       ``(A) reserve a portion (not less than 2 percent) of the 
     funds appropriated with respect to each program carried out 
     under this part; and
       ``(B) use the funds reserved under subparagraph (A) to 
     provide assistance to eligible entities to conduct 
     evaluations of the activities funded under each program 
     carried out under this part.
       ``(2) Certified ehr technology grant program not 
     included.--The provisions of this subsection shall not apply 
     to the certified EHR technology grant program under section 
     2041(b).
       ``(3) Authorized activities.--A recipient of assistance 
     described in paragraph (1)(B) shall use the funds made 
     available through the assistance to conduct a validated 
     evaluation of the effectiveness of the activities funded 
     under a program carried out under this part.
       ``(4) Applications.--To be eligible to receive assistance 
     under paragraph (1)(B), an entity shall submit an application 
     to the Secretary at such time, in such manner, and containing 
     such information as the Secretary may require, including a 
     proposal for the evaluation.
       ``(5) Reports.--Not later than a date specified by the 
     Secretary, an eligible entity receiving assistance under 
     paragraph (1)(B) shall submit to the Secretary, the Committee 
     on Ways and Means and the Committee on Energy and Commerce of 
     the House of Representatives, and the Committee on Finance of 
     the Senate a report containing the results of the evaluation 
     conducted using such assistance together with such 
     recommendations as the entity determines to be appropriate.
       ``(c) Evaluations and Audits of Certified EHR Technology 
     Grant Program by the Secretary.--
       ``(1) Evaluations.--The Secretary shall conduct an 
     evaluation of the activities funded under the certified EHR 
     technology grant program under section 2041(b). Such 
     evaluation shall include an evaluation of whether the funding 
     provided under the grant is expended only for the purposes 
     for which it is made.
       ``(2) Audits.--The Secretary shall conduct appropriate 
     audits of grants made under section 2041(b).

     ``SEC. 2045. REPORT.

       ``Not later than October 1, 2014, the Secretary shall 
     submit to the Elder Justice Coordinating Council established 
     under section 2021, the Committee on Ways and Means and the 
     Committee on Energy and Commerce of the House of 
     Representatives, and the Committee on Finance of the Senate a 
     report--
       ``(1) compiling, summarizing, and analyzing the information 
     contained in the State reports submitted under subsections 
     (b)(4) and (c)(4) of section 2042; and
       ``(2) containing such recommendations for legislative or 
     administrative action as the Secretary determines to be 
     appropriate.

     ``SEC. 2046. RULE OF CONSTRUCTION.

       ``Nothing in this subtitle shall be construed as--
       ``(1) limiting any cause of action or other relief related 
     to obligations under this subtitle that is available under 
     the law of any State, or political subdivision thereof; or
       ``(2) creating a private cause of action for a violation of 
     this subtitle.''.
       (2) Option for state plan under program for temporary 
     assistance for needy families.--
       (A) In general.--Section 402(a)(1)(B) of the Social 
     Security Act (42 U.S.C. 602(a)(1)(B)) is amended by adding at 
     the end the following new clause:
       ``(v) The document shall indicate whether the State intends 
     to assist individuals to train for, seek, and maintain 
     employment--

       ``(I) providing direct care in a long-term care facility 
     (as such terms are defined under section 2011); or
       ``(II) in other occupations related to elder care 
     determined appropriate by the State for which the State 
     identifies an unmet need for service personnel,

     and, if so, shall include an overview of such assistance.''.
       (B) Effective date.--The amendment made by subparagraph (A) 
     shall take effect on January 1, 2011.
       (b) Protecting Residents of Long-Term Care Facilities.--
       (1) National training institute for surveyors.--
       (A) In general.--The Secretary of Health and Human Services 
     shall enter into a contract with an entity for the purpose of 
     establishing and operating a National Training Institute for 
     Federal and State surveyors. Such Institute shall provide and 
     improve the training of surveyors with respect to 
     investigating allegations of abuse, neglect, and 
     misappropriation of property in programs and long-term care 
     facilities that receive payments under a State health 
     security program.
       (B) Activities carried out by the institute.--The contract 
     entered into under subparagraph (A) shall require the 
     Institute established and operated under such contract to 
     carry out the following activities:
       (i) Assess the extent to which State agencies use 
     specialized surveyors for the investigation of reported 
     allegations of abuse, neglect, and misappropriation of 
     property in such programs and long-term care facilities.
       (ii) Evaluate how the competencies of surveyors may be 
     improved to more effectively investigate reported allegations 
     of such abuse, neglect, and misappropriation of property, and 
     provide feedback to Federal and State agencies on the 
     evaluations conducted.
       (iii) Provide a national program of training, tools, and 
     technical assistance to Federal and State surveyors on 
     investigating reports of such abuse, neglect, and 
     misappropriation of property.
       (iv) Develop and disseminate information on best practices 
     for the investigation of such abuse, neglect, and 
     misappropriation of property.
       (v) Assess the performance of State complaint intake 
     systems, in order to ensure that the intake of complaints 
     occurs 24 hours per day, 7 days a week (including holidays).
       (vi) To the extent approved by the Secretary of Health and 
     Human Services, provide a national 24 hours per day, 7 days a

[[Page S12243]]

     week (including holidays), back-up system to State complaint 
     intake systems in order to ensure optimum national 
     responsiveness to complaints of such abuse, neglect, and 
     misappropriation of property.
       (vii) Analyze and report annually on the following:

       (I) The total number and sources of complaints of such 
     abuse, neglect, and misappropriation of property.
       (II) The extent to which such complaints are referred to 
     law enforcement agencies.
       (III) General results of Federal and State investigations 
     of such complaints.

       (viii) Conduct a national study of the cost to State 
     agencies of conducting complaint investigations of skilled 
     nursing facilities and nursing facilities under sections 1819 
     and 1919, respectively, of the Social Security Act (42 U.S.C. 
     1395i-3; 1396r), and making recommendations to the Secretary 
     of Health and Human Services with respect to options to 
     increase the efficiency and cost-effectiveness of such 
     investigations.
       (C) Authorization.--There are authorized to be appropriated 
     to carry out this paragraph, for the period of fiscal years 
     2011 through 2014, $12,000,000.
       (2) Grants to state survey agencies.--
       (A) In general.--The Secretary of Health and Human Services 
     shall make grants to State agencies that perform surveys of 
     skilled nursing facilities or nursing facilities under 
     sections 1819 or 1919, respectively, of the Social Security 
     Act (42 U.S.C. 1395i-3; 1395r).
       (B) Use of funds.--A grant awarded under subparagraph (A) 
     shall be used for the purpose of designing and implementing 
     complaint investigations systems that--
       (i) promptly prioritize complaints in order to ensure a 
     rapid response to the most serious and urgent complaints;
       (ii) respond to complaints with optimum effectiveness and 
     timeliness; and
       (iii) optimize the collaboration between local authorities, 
     consumers, and providers, including--

       (I) such State agency;
       (II) the State Long-Term Care Ombudsman;
       (III) local law enforcement agencies;
       (IV) advocacy and consumer organizations;
       (V) State aging units;
       (VI) Area Agencies on Aging; and
       (VII) other appropriate entities.

       (C) Authorization.--There are authorized to be appropriated 
     to carry out this paragraph, for each of fiscal years 2011 
     through 2014, $5,000,000.
       (3) Reporting of crimes in federally funded long-term care 
     facilities.--Part A of title XI of the Social Security Act 
     (42 U.S.C. 1301 et seq.), as amended by section 5005, is 
     amended by inserting after section 1150A the following new 
     section:


``reporting to law enforcement of crimes occurring in federally funded 
                       long-term care facilities

       ``Sec. 1150B.  (a) Determination and Notification.--
       ``(1) Determination.--The owner or operator of each long-
     term care facility that receives Federal funds under this Act 
     shall annually determine whether the facility received at 
     least $10,000 in such Federal funds during the preceding 
     year.
       ``(2) Notification.--If the owner or operator determines 
     under paragraph (1) that the facility received at least 
     $10,000 in such Federal funds during the preceding year, such 
     owner or operator shall annually notify each covered 
     individual (as defined in paragraph (3)) of that individual's 
     obligation to comply with the reporting requirements 
     described in subsection (b).
       ``(3) Covered individual defined.--In this section, the 
     term `covered individual' means each individual who is an 
     owner, operator, employee, manager, agent, or contractor of a 
     long-term care facility that is the subject of a 
     determination described in paragraph (1).
       ``(b) Reporting Requirements.--
       ``(1) In general.--Each covered individual shall report to 
     the Secretary and 1 or more law enforcement entities for the 
     political subdivision in which the facility is located any 
     reasonable suspicion of a crime (as defined by the law of the 
     applicable political subdivision) against any individual who 
     is a resident of, or is receiving care from, the facility.
       ``(2) Timing.--If the events that cause the suspicion--
       ``(A) result in serious bodily injury, the individual shall 
     report the suspicion immediately, but not later than 2 hours 
     after forming the suspicion; and
       ``(B) do not result in serious bodily injury, the 
     individual shall report the suspicion not later than 24 hours 
     after forming the suspicion.
       ``(c) Penalties.--
       ``(1) In general.--If a covered individual violates 
     subsection (b)--
       ``(A) the covered individual shall be subject to a civil 
     money penalty of not more than $200,000; and
       ``(B) the Secretary may make a determination in the same 
     proceeding to exclude the covered individual from 
     participation in any Federal health care program (as defined 
     in section 1128B(f)).
       ``(2) Increased harm.--If a covered individual violates 
     subsection (b) and the violation exacerbates the harm to the 
     victim of the crime or results in harm to another 
     individual--
       ``(A) the covered individual shall be subject to a civil 
     money penalty of not more than $300,000; and
       ``(B) the Secretary may make a determination in the same 
     proceeding to exclude the covered individual from 
     participation in any Federal health care program (as defined 
     in section 1128B(f)).
       ``(3) Excluded individual.--During any period for which a 
     covered individual is classified as an excluded individual 
     under paragraph (1)(B) or (2)(B), a long-term care facility 
     that employs such individual shall be ineligible to receive 
     Federal funds under this Act.
       ``(4) Extenuating circumstances.--
       ``(A) In general.--The Secretary may take into account the 
     financial burden on providers with underserved populations in 
     determining any penalty to be imposed under this subsection.
       ``(B) Underserved population defined.--In this paragraph, 
     the term `underserved population' means the population of an 
     area designated by the Secretary as an area with a shortage 
     of elder justice programs or a population group designated by 
     the Secretary as having a shortage of such programs. Such 
     areas or groups designated by the Secretary may include--
       ``(i) areas or groups that are geographically isolated 
     (such as isolated in a rural area);
       ``(ii) racial and ethnic minority populations; and
       ``(iii) populations underserved because of special needs 
     (such as language barriers, disabilities, alien status, or 
     age).
       ``(d) Additional Penalties for Retaliation.--
       ``(1) In general.--A long-term care facility may not--
       ``(A) discharge, demote, suspend, threaten, harass, or deny 
     a promotion or other employment-related benefit to an 
     employee, or in any other manner discriminate against an 
     employee in the terms and conditions of employment because of 
     lawful acts done by the employee; or
       ``(B) file a complaint or a report against a nurse or other 
     employee with the appropriate State professional disciplinary 
     agency because of lawful acts done by the nurse or employee,
     for making a report, causing a report to be made, or for 
     taking steps in furtherance of making a report pursuant to 
     subsection (b)(1).
       ``(2) Penalties for retaliation.--If a long-term care 
     facility violates subparagraph (A) or (B) of paragraph (1) 
     the facility shall be subject to a civil money penalty of not 
     more than $200,000 or the Secretary may classify the entity 
     as an excluded entity for a period of 2 years pursuant to 
     section 1128(b), or both.
       ``(3) Requirement to post notice.--Each long-term care 
     facility shall post conspicuously in an appropriate location 
     a sign (in a form specified by the Secretary) specifying the 
     rights of employees under this section. Such sign shall 
     include a statement that an employee may file a complaint 
     with the Secretary against a long-term care facility that 
     violates the provisions of this subsection and information 
     with respect to the manner of filing such a complaint.
       ``(e) Procedure.--The provisions of section 1128A (other 
     than subsections (a) and (b) and the second sentence of 
     subsection (f)) shall apply to a civil money penalty or 
     exclusion under this section in the same manner as such 
     provisions apply to a penalty or proceeding under section 
     1128A(a).
       ``(f) Definitions.--In this section, the terms `elder 
     justice', `long-term care facility', and `law enforcement' 
     have the meanings given those terms in section 2011.''.
       (c) National Nurse Aide Registry.--
       (1) Definition of nurse aide.--In this subsection, the term 
     ``nurse aide'' has the meaning given that term in sections 
     1819(b)(5)(F) and 1919(b)(5)(F) of the Social Security Act 
     (42 U.S.C. 1395i-3(b)(5)(F); 1396r(b)(5)(F)).
       (2) Study and report.--
       (A) In general.--The Secretary, in consultation with 
     appropriate government agencies and private sector 
     organizations, shall conduct a study on establishing a 
     national nurse aide registry.
       (B) Areas evaluated.--The study conducted under this 
     subsection shall include an evaluation of--
       (i) who should be included in the registry;
       (ii) how such a registry would comply with Federal and 
     State privacy laws and regulations;
       (iii) how data would be collected for the registry;
       (iv) what entities and individuals would have access to the 
     data collected;
       (v) how the registry would provide appropriate information 
     regarding violations of Federal and State law by individuals 
     included in the registry;
       (vi) how the functions of a national nurse aide registry 
     would be coordinated with the nationwide program for national 
     and State background checks on direct patient access 
     employees of long-term care facilities and providers under 
     section 4301; and
       (vii) how the information included in State nurse aide 
     registries developed and maintained under sections 1819(e)(2) 
     and 1919(e)(2) of the Social Security Act (42 U.S.C. 1395i-
     3(e)(2); 1396r(e)(2)(2)) would be provided as part of a 
     national nurse aide registry.
       (C) Considerations.--In conducting the study and preparing 
     the report required under this subsection, the Secretary 
     shall take into consideration the findings and conclusions of 
     relevant reports and other relevant resources, including the 
     following:
       (i) The Department of Health and Human Services Office of 
     Inspector General Report,

[[Page S12244]]

     Nurse Aide Registries: State Compliance and Practices 
     (February 2005).
       (ii) The General Accounting Office (now known as the 
     Government Accountability Office) Report, Nursing Homes: More 
     Can Be Done to Protect Residents from Abuse (March 2002).
       (iii) The Department of Health and Human Services Office of 
     the Inspector General Report, Nurse Aide Registries: Long-
     Term Care Facility Compliance and Practices (July 2005).
       (iv) The Department of Health and Human Services Health 
     Resources and Services Administration Report, Nursing Aides, 
     Home Health Aides, and Related Health Care Occupations--
     National and Local Workforce Shortages and Associated Data 
     Needs (2004) (in particular with respect to chapter 7 and 
     appendix F).
       (v) The 2001 Report to CMS from the School of Rural Public 
     Health, Texas A&M University, Preventing Abuse and Neglect in 
     Nursing Homes: The Role of Nurse Aide Registries.
       (vi) Information included in State nurse aide registries 
     developed and maintained under sections 1819(e)(2) and 
     1919(e)(2) of the Social Security Act (42 U.S.C. 1395i-
     3(e)(2); 1396r(e)(2)(2)).
       (D) Report.--Not later than 18 months after the date of 
     enactment of this Act, the Secretary shall submit to the 
     Elder Justice Coordinating Council established under section 
     2021 of the Social Security Act, as added by section 1805(a), 
     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 containing the findings 
     and recommendations of the study conducted under this 
     paragraph.
       (E) Funding limitation.--Funding for the study conducted 
     under this subsection shall not exceed $500,000.
       (3) Congressional action.--After receiving the report 
     submitted by the Secretary under paragraph (2)(D), 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 shall, as they deem appropriate, 
     take action based on the recommendations contained in the 
     report.
       (4) Authorization of appropriations.--There are authorized 
     to be appropriated such sums as are necessary for the purpose 
     of carrying out this subsection.
       (d) Conforming Amendments.--
       (1) Title xx.--Title XX of the Social Security Act (42 
     U.S.C. 1397 et seq.), as amended by section 5503(a), is 
     amended--
       (A) in the heading of section 2001, by striking ``title'' 
     and inserting ``subtitle''; and
       (B) in subtitle 1, by striking ``this title'' each place it 
     appears and inserting ``this subtitle''.
       (2) Title iv.--Title IV of the Social Security Act (42 
     U.S.C. 601 et seq.) is amended--
       (A) in section 404(d)--
       (i) in paragraphs (1)(A), (2)(A), and (3)(B), by inserting 
     ``subtitle 1 of'' before ``title XX'' each place it appears;
       (ii) in the heading of paragraph (2), by inserting 
     ``subtitle of'' before ``title xx''; and
       (iii) in the heading of paragraph (3)(B), by inserting 
     ``subtitle of'' before ``title xx''; and
       (B) in sections 422(b), 471(a)(4), 472(h)(1), and 
     473(b)(2), by inserting ``subtitle 1 of'' before ``title XX'' 
     each place it appears.
       (3) Title xi.--Title XI of the Social Security Act (42 
     U.S.C. 1301 et seq.) is amended--
       (A) in section 1128(h)(3)--
       (i) by inserting ``subtitle 1 of'' before ``title XX''; and
       (ii) by striking ``such title'' and inserting ``such 
     subtitle''; and
       (B) in section 1128A(i)(1), by inserting ``subtitle 1 of'' 
     before ``title XX''.

     Subtitle G--Sense of the Senate Regarding Medical Malpractice

     SEC. 5501. SENSE OF THE SENATE REGARDING MEDICAL MALPRACTICE.

       It is the sense of the Senate that--
       (1) health care reform presents an opportunity to address 
     issues related to medical malpractice and medical liability 
     insurance;
       (2) States should be encouraged to develop and test 
     alternatives to the existing civil litigation system as a way 
     of improving patient safety, reducing medical errors, 
     encouraging the efficient resolution of disputes, increasing 
     the availability of prompt and fair resolution of disputes, 
     and improving access to liability insurance, while preserving 
     an individual's right to seek redress in court; and
       (3) Congress should consider establishing a State 
     demonstration program to evaluate alternatives to the 
     existing civil litigation system with respect to the 
     resolution of medical malpractice claims.

       TITLE VI--IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES

         Subtitle A--Biologics Price Competition and Innovation

     SEC. 6001. 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. 6002. 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

[[Page S12245]]

     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.

[[Page S12246]]

       ``(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

[[Page S12247]]

     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

[[Page S12248]]

     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) Pediatric Studies of Biological Products.--
       (1) In general.--Section 351 of the Public Health Service 
     Act (42 U.S.C. 262) is amended by adding at the end the 
     following:
       ``(m) Pediatric Studies.--
       ``(1) Application of certain provisions.--The provisions of 
     subsections (a), (d), (e), (f), (i), (j), (k), (l), (p), and 
     (q) of section 505A of the Federal Food, Drug, and Cosmetic 
     Act shall apply with respect to the extension of a period 
     under paragraphs (2) and (3) to the same extent and in the 
     same manner as such provisions apply with respect to the 
     extension of a period under subsection (b) or (c) of section 
     505A of the Federal Food, Drug, and Cosmetic Act.
       ``(2) Market exclusivity for new biological products.--If, 
     prior to approval of an application that is submitted under 
     subsection (a), the Secretary determines that information 
     relating to the use of a new biological product in the 
     pediatric population may produce health benefits in that 
     population, the Secretary makes a written request for 
     pediatric studies (which shall include a timeframe for 
     completing such studies), the applicant agrees to the 
     request, such studies are completed using appropriate 
     formulations for each age group for which the study is 
     requested within any such timeframe, and the reports thereof 
     are submitted and accepted in accordance with section 
     505A(d)(3) of the Federal Food, Drug, and Cosmetic Act--
       ``(A) the periods for such biological product referred to 
     in subsection (k)(7) are deemed to be 4 years and 6 months 
     rather than 4 years and 12 years and 6 months rather than 12 
     years; and
       ``(B) if the biological product is designated under section 
     526 for a rare disease or condition, the period for such 
     biological product referred to in section 527(a) is deemed to 
     be 7 years and 6 months rather than 7 years.
       ``(3) Market exclusivity for already-marketed biological 
     products.--If the Secretary determines that information 
     relating to the use of a licensed biological product in the 
     pediatric population may produce health benefits in that 
     population and makes a written request to the holder of an 
     approved application under subsection (a) for pediatric 
     studies (which shall include a timeframe for completing such 
     studies), the holder agrees to the request, such studies are 
     completed using appropriate formulations for each age group 
     for which the study is requested within any such timeframe, 
     and the reports thereof are submitted and accepted in 
     accordance with section 505A(d)(3) of the Federal Food, Drug, 
     and Cosmetic Act--
       ``(A) the periods for such biological product referred to 
     in subsection (k)(7) are deemed to be 4 years and 6 months 
     rather than 4 years and 12 years and 6 months rather than 12 
     years; and
       ``(B) if the biological product is designated under section 
     526 for a rare disease or condition, the period for such 
     biological product referred to in section 527(a) is deemed to 
     be 7 years and 6 months rather than 7 years.
       ``(4) Exception.--The Secretary shall not extend a period 
     referred to in paragraph (2)(A), (2)(B), (3)(A), or (3)(B) if 
     the determination under section 505A(d)(3) is made later than 
     9 months prior to the expiration of such period.''.
       (2) Studies regarding pediatric research.--
       (A) Program for pediatric study of drugs.--Subsection 
     (a)(1) of section 409I of the Public Health Service Act (42 
     U.S.C. 284m) is amended by inserting ``, biological 
     products,'' after ``including drugs''.
       (B) Institute of medicine study.--Section 505A(p) of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355b(p)) is 
     amended by striking paragraphs (4) and (5) and inserting the 
     following:
       ``(4) review and assess the number and importance of 
     biological products for children that are being tested as a 
     result of the amendments made by the Biologics Price 
     Competition and Innovation Act of 2009 and the importance for 
     children, health care providers, parents, and others of 
     labeling changes made as a result of such testing;
       ``(5) review and assess the number, importance, and 
     prioritization of any biological products that are not being 
     tested for pediatric use; and
       ``(6) offer recommendations for ensuring pediatric testing 
     of biological products, including consideration of any 
     incentives, such as those provided under this section or 
     section 351(m) of the Public Health Service Act.''.
       (h) 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. 6003. 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.

[[Page S12249]]

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

     SEC. 6101. 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) 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).
       ``(N) 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), or (N) 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), or (N) 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), or (N) 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) Effective Dates.--
       (1) In general.--The amendments made by this section and 
     section 6102 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 6102 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. 6102. 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 the Patient 
     Protection and Affordable Care 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 health security 
     programs 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

[[Page S12250]]

     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 subsection (a)(5)(E), 
     through one or more of the following actions:

       ``(I) Where a covered entity knowingly and intentionally 
     violates subsection (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 subsection (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 
     subsection (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 the Patient Protection and Affordable Care 
     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 6101(c), by inserting ``after audit 
     as described in subparagraph (D) and'' after ``finds,''.

     SEC. 6103. 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.
                                 ______
                                 
  SA 2838. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 182, strike line 20 and all that follows 
     through line 11 on page 183, and insert the following:
       (b) Establishment of Community Health Insurance Option.--
       (1) Establishment.--The Secretary shall establish a 
     community health insurance option to offer, through the 
     Exchanges established under this title, health
       Beginning on page 187, strike line 17 and all that follows 
     through line 8 on page 188, and insert the following:
       (6) Reimbursement rates.--
       (A) Rates established by secretary.--
       (i) In general.--The Secretary shall establish payment 
     rates for the community health insurance option for services 
     and health care providers consistent with this section and 
     may change such payment rates.
       (ii) Initial payment rules.--

       (I) In general.--Except as provided in subclause (II), 
     during the first 3 years in which the community health 
     insurance option if offered, the Secretary shall base the 
     payment rates under this section for services and providers 
     described in subparagraph (A) on the payment rates for 
     similar services and providers under parts A and B of 
     Medicare under title XVIII of the Social Security Act.
       (II) Exceptions.--

       (aa) Payment rates for practitioners services.--Payment 
     rates for practitioners services otherwise established under 
     the fee schedule under section 1848 of the Social Security 
     Act shall be applied without regard to the provisions under 
     subsection (f) of such section and the update under 
     subsection (d)(4) under such section for a year as applied 
     under this subparagraph shall be not less than 1 percent.
       (bb) Adjustments.--The Secretary may determine the extent 
     to which Medicare adjustments applicable to base payment 
     rates under parts A and B of Medicare shall apply under this 
     section.
       (iii) For new services.--The Secretary shall modify payment 
     rates described in clause (ii) in order to accommodate 
     payments for services, such as well-child visits, that are 
     not otherwise covered under Medicare.
       (iv) Prescription drugs.--Payment rates under this 
     paragraph for prescription drugs that are not paid for under 
     part A or part B of Medicare shall be at rates negotiated by 
     the Secretary.
       (B) Incentives for participating providers.--
       (i) Initial incentive period.--

       (I) In general.--The Secretary shall provide, in the case 
     of services described in subclause (II) furnished during the 
     first 3 years in which a community health insurance option is 
     offered, for payment rates that are 5 percent greater than 
     the rates established under subparagraph (A).
       (II) Services described.--The services described in this 
     subclause are items and professional services, under the 
     community health insurance option by a physician or other 
     health care practitioner who participates in both Medicare 
     and the community health insurance option.
       (III) Special rules.--A pediatrician and any other health 
     care practitioner who is a type of practitioner that does not 
     typically participate in Medicare (as determined by

[[Page S12251]]

     the Secretary) shall also be eligible for the increased 
     payment rates under subclause (I).

       (ii) Subsequent periods.--Beginning with the fourth year in 
     which the community health insurance option is offered, and 
     for subsequent years, the Secretary shall continue to use an 
     administrative process to set such rates in order to promote 
     payment accuracy, to ensure adequate beneficiary access to 
     providers, and to promote affordability and the efficient 
     delivery of medical care. Such rates shall not be set at 
     levels expected to increase overall medical costs under the 
     option beyond what would be expected if the process under 
     subparagraph (A)(ii) and clause (i) of this subparagraph were 
     continued.
       (iii) Establishment of a provider network.--Health care 
     providers participating under Medicare are participating 
     providers in the community health insurance option unless 
     they opt out in a process established by the Secretary.
       (C) Administrative process for setting rates.--Chapter 5 of 
     title 5, United States Code shall apply to the process for 
     the initial establishment of payment rates under this 
     paragraph but not to the specific methodology for 
     establishing such rates or the calculation of such rates.
       (D) Construction.--Nothing in this subtitle shall be 
     construed--
       (i) as limiting the Secretary's authority to correct for 
     payments that are excessive or deficient, taking into account 
     the amounts paid for similar health care providers and 
     services under other Exchange-participating qualified health 
     plans.
       (ii) as affecting the authority of the Secretary to 
     establish payment rates, including payments to provide for 
     the more efficient delivery of services.
       (E) Limitation on review.--There shall be no administrative 
     or judicial review of a payment rate or methodology 
     established under this paragraph.
                                 ______
                                 
  SA 2839. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 182, strike line 20 and all that follows 
     through line 8 on page 188, and insert the following:
       (b) Establishment of Community Health Insurance Option.--
       (1) Establishment.--The Secretary shall establish a 
     community health insurance option to offer, through the 
     Exchanges 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 sufficient choice of providers; and
       (G) complies with State laws (if any), except as otherwise 
     provided for in this title, relating to the laws described in 
     section 1324(b).
       (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 1302(b).
       (B) States may offer additional benefits.--Nothing in this 
     section shall preclude a State from requiring that benefits 
     in addition to the essential health benefits required under 
     subparagraph (A) be provided to enrollees of a community 
     health insurance option offered in such State.
       (C) Credits.--
       (i) In general.--An individual enrolled in a community 
     health insurance option under this section shall be eligible 
     for credits under section 36B of the Internal Revenue Code of 
     1986 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 benefits in addition to the 
     essential health benefits required under subparagraph (A) be 
     provided to enrollees of a community health insurance option 
     shall not affect the amount of a premium tax credit provided 
     under section 36B of the Internal Revenue Code of 1986 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 subparagraph (B) 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 levels of coverage 
     described in section 1302(d).
       (5) Premiums.--
       (A) Premiums sufficient to cover costs.--The Secretary 
     shall establish geographically adjusted 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 of the 
     Public Health Service Act relating to premiums shall apply to 
     community health insurance options under this section, 
     including modified community rating provisions under section 
     2701 of such Act.
       (C) Collection of data.--The Secretary shall collect data 
     as necessary to set premium rates under subparagraph (A).
       (D) National pooling.--Notwithstanding any other provision 
     of law, the Secretary may treat all enrollees in community 
     health insurance options as members of a single pool.
       (E) Contingency margin.--In establishing premium rates 
     under subparagraph (A), the Secretary shall include an 
     appropriate amount for a contingency margin.
       (6) Reimbursement rates.--
       (A) Rates established by secretary.--
       (i) In general.--The Secretary shall establish payment 
     rates for the community health insurance option for services 
     and health care providers consistent with this section and 
     may change such payment rates.
       (ii) Initial payment rules.--

       (I) In general.--Except as provided in subclause (II), 
     during the first 3 years in which the community health 
     insurance option if offered, the Secretary shall base the 
     payment rates under this section for services and providers 
     described in subparagraph (A) on the payment rates for 
     similar services and providers under parts A and B of 
     Medicare under title XVIII of the Social Security Act.
       (II) Exceptions.--

       (aa) Payment rates for practitioners services.--Payment 
     rates for practitioners services otherwise established under 
     the fee schedule under section 1848 of the Social Security 
     Act shall be applied without regard to the provisions under 
     subsection (f) of such section and the update under 
     subsection (d)(4) under such section for a year as applied 
     under this subparagraph shall be not less than 1 percent.
       (bb) Adjustments.--The Secretary may determine the extent 
     to which Medicare adjustments applicable to base payment 
     rates under parts A and B of Medicare shall apply under this 
     section.
       (iii) For new services.--The Secretary shall modify payment 
     rates described in clause (ii) in order to accommodate 
     payments for services, such as well-child visits, that are 
     not otherwise covered under Medicare.
       (iv) Prescription drugs.--Payment rates under this 
     paragraph for prescription drugs that are not paid for under 
     part A or part B of Medicare shall be at rates negotiated by 
     the Secretary.
       (B) Incentives for participating providers.--
       (i) Initial incentive period.--

       (I) In general.--The Secretary shall provide, in the case 
     of services described in subclause (II) furnished during the 
     first 3 years in which a community health insurance option is 
     offered, for payment rates that are 5 percent greater than 
     the rates established under subparagraph (A).
       (II) Services described.--The services described in this 
     subclause are items and professional services, under the 
     community health insurance option by a physician or other 
     health care practitioner who participates in both Medicare 
     and the community health insurance option.
       (III) Special rules.--A pediatrician and any other health 
     care practitioner who is a type of practitioner that does not 
     typically participate in Medicare (as determined by the 
     Secretary) shall also be eligible for the increased payment 
     rates under subclause (I).

       (ii) Subsequent periods.--Beginning with the fourth year in 
     which the community health insurance option is offered, and 
     for subsequent years, the Secretary shall continue to use an 
     administrative process to set such rates in order to promote 
     payment accuracy, to ensure adequate beneficiary access to 
     providers, and to promote affordablility and the efficient 
     delivery of medical care. Such rates shall not be set at 
     levels expected to increase overall medical costs under the 
     option beyond what would be expected if the process under 
     subparagraph (A)(ii) and clause (i) of this subparagraph were 
     continued.
       (iii) Establishment of a provider network.--Health care 
     providers participating under Medicare are participating 
     providers in the community health insurance option

[[Page S12252]]

     unless they opt out in a process established by the 
     Secretary.
       (C) Administrative process for setting rates.--Chapter 5 of 
     title 5, United States Code shall apply to the process for 
     the initial establishment of payment rates under this 
     paragraph but not to the specific methodology for 
     establishing such rates or the calculation of such rates.
       (D) Construction.--Nothing in this subtitle shall be 
     construed--
       (i) as limiting the Secretary's authority to correct for 
     payments that are excessive or deficient, taking into account 
     the amounts paid for similar health care providers and 
     services under other Exchange-participating qualified health 
     plans.
       (ii) as affecting the authority of the Secretary to 
     establish payment rates, including payments to provide for 
     the more efficient delivery of services.
       (E) Limitation on review.--There shall be no administrative 
     or judicial review of a payment rate or methodology 
     established under this paragraph.
                                 ______
                                 
  SA 2840. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 182, strike line 20 and all that follows 
     through line 11 on page 183, and insert the following:
       (b) Establishment of Community Health Insurance Option.--
       (1) Establishment.--The Secretary shall establish a 
     community health insurance option to offer, through the 
     Exchanges established under this title, health
                                 ______
                                 
  SA 2841. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 187, strike line 17 and all that follows 
     through line 8 on page 188, and insert the following:
       (6) Reimbursement rates.--
       (A) Rates established by secretary.--
       (i) In general.--The Secretary shall establish payment 
     rates for the community health insurance option for services 
     and health care providers consistent with this section and 
     may change such payment rates.
       (ii) Initial payment rules.--

       (I) In general.--Except as provided in subclause (II), 
     during the first 3 years in which the community health 
     insurance option if offered, the Secretary shall base the 
     payment rates under this section for services and providers 
     described in subparagraph (A) on the payment rates for 
     similar services and providers under parts A and B of 
     Medicare under title XVIII of the Social Security Act.
       (II) Exceptions.--

       (aa) Payment rates for practitioners services.--Payment 
     rates for practitioners services otherwise established under 
     the fee schedule under section 1848 of the Social Security 
     Act shall be applied without regard to the provisions under 
     subsection (f) of such section and the update under 
     subsection (d)(4) under such section for a year as applied 
     under this subparagraph shall be not less than 1 percent.
       (bb) Adjustments.--The Secretary may determine the extent 
     to which Medicare adjustments applicable to base payment 
     rates under parts A and B of Medicare shall apply under this 
     section.
       (iii) For new services.--The Secretary shall modify payment 
     rates described in clause (ii) in order to accommodate 
     payments for services, such as well-child visits, that are 
     not otherwise covered under Medicare.
       (iv) Prescription drugs.--Payment rates under this 
     paragraph for prescription drugs that are not paid for under 
     part A or part B of Medicare shall be at rates negotiated by 
     the Secretary.
       (B) Incentives for participating providers.--
       (i) Initial incentive period.--

       (I) In general.--The Secretary shall provide, in the case 
     of services described in subclause (II) furnished during the 
     first 3 years in which a community health insurance option is 
     offered, for payment rates that are 5 percent greater than 
     the rates established under subparagraph (A).
       (II) Services described.--The services described in this 
     subclause are items and professional services, under the 
     community health insurance option by a physician or other 
     health care practitioner who participates in both Medicare 
     and the community health insurance option.
       (III) Special rules.--A pediatrician and any other health 
     care practitioner who is a type of practitioner that does not 
     typically participate in Medicare (as determined by the 
     Secretary) shall also be eligible for the increased payment 
     rates under subclause (I).

       (ii) Subsequent periods.--Beginning with the fourth year in 
     which the community health insurance option is offered, and 
     for subsequent years, the Secretary shall continue to use an 
     administrative process to set such rates in order to promote 
     payment accuracy, to ensure adequate beneficiary access to 
     providers, and to promote affordablility and the efficient 
     delivery of medical care. Such rates shall not be set at 
     levels expected to increase overall medical costs under the 
     option beyond what would be expected if the process under 
     subparagraph (A)(ii) and clause (i) of this subparagraph were 
     continued.
       (iii) Establishment of a provider network.--Health care 
     providers participating under Medicare are participating 
     providers in the community health insurance option unless 
     they opt out in a process established by the Secretary.
       (C) Administrative process for setting rates.--Chapter 5 of 
     title 5, United States Code shall apply to the process for 
     the initial establishment of payment rates under this 
     paragraph but not to the specific methodology for 
     establishing such rates or the calculation of such rates.
       (D) Construction.--Nothing in this subtitle shall be 
     construed--
       (i) as limiting the Secretary's authority to correct for 
     payments that are excessive or deficient, taking into account 
     the amounts paid for similar health care providers and 
     services under other Exchange-participating qualified health 
     plans.
       (ii) as affecting the authority of the Secretary to 
     establish payment rates, including payments to provide for 
     the more efficient delivery of services.
       (E) Limitation on review.--There shall be no administrative 
     or judicial review of a payment rate or methodology 
     established under this paragraph.
                                 ______
                                 
  SA 2842. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 249, strike lines 3 through 12, and insert the 
     following:
       (ii) Coverage must provide minimum value and essential 
     benefits.--Except as provided in clause (iii), an employee 
     shall not be treated as eligible for minimum essential 
     coverage if such coverage consists of an eligible employer-
     sponsored plan (as defined in section 5000A(f)(2)) and--

       (I) the plan's share of the total allowed costs of benefits 
     provided under the plan is less than 60 percent of such 
     costs, or
       (II) the plan does not provide coverage for at least the 
     essential health benefits required to be provided by a 
     qualified health plan under section 1302(b) of the Patient 
     Protection and Affordable Care Act.

                                 ______
                                 
  SA 2843. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 268, after line 19, insert the following:

     SEC. 1403. EMPLOYEES ELIGIBLE FOR CREDIT AND REDUCTIONS IF 
                   EMPLOYER'S PLAN DOESN'T COVER ESSENTIAL HEALTH 
                   BENEFITS.

       (a) In General.--Section 36B(c)(2)(C)(ii) of the Internal 
     Revenue Code of 1986, as added by section 1401, is amended to 
     read as follows:
       ``(ii) Coverage must provide minimum value and essential 
     benefits.--Except as provided in clause (iii), an employee 
     shall not be treated as eligible for minimum essential 
     coverage if such coverage consists of an eligible employer-
     sponsored plan (as defined in section 5000A(f)(2)) and--

       ``(I) the plan's share of the total allowed costs of 
     benefits provided under the plan is less than 60 percent of 
     such costs, or
       ``(II) the plan does not provide coverage for at least the 
     essential health benefits required to be provided by a 
     qualified health plan under section 1302(b) of the Patient 
     Protection and Affordable Care Act.''.

       (b) Surcharge on High Income Individuals.--
       (1) In general.--Subchapter A of chapter 1 of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new part:

           ``PART VIII--SURCHARGE ON HIGH INCOME INDIVIDUALS

``Sec. 59B. Surcharge on high income individuals.

     ``SEC. 59B. SURCHARGE ON HIGH INCOME INDIVIDUALS.

       ``(a) General Rule.--In the case of a taxpayer other than a 
     corporation, there is hereby imposed (in addition to any 
     other tax imposed by this subtitle) a tax equal to 5.4

[[Page S12253]]

     percent of so much of the modified adjusted gross income of 
     the taxpayer as exceeds $1,000,000.
       ``(b) Taxpayers Not Making a Joint Return.--In the case of 
     any taxpayer other than a taxpayer making a joint return 
     under section 6013 or a surviving spouse (as defined in 
     section 2(a)), subsection (a) shall be applied by 
     substituting `$500,000' for `$1,000,000'.
       ``(c) Modified Adjusted Gross Income.--For purposes of this 
     section, the term `modified adjusted gross income' means 
     adjusted gross income reduced by any deduction (not taken 
     into account in determining adjusted gross income) allowed 
     for investment interest (as defined in section 163(d)). In 
     the case of an estate or trust, adjusted gross income shall 
     be determined as provided in section 67(e).
       ``(d) Special Rules.--
       ``(1) Nonresident alien.--In the case of a nonresident 
     alien individual, only amounts taken into account in 
     connection with the tax imposed under section 871(b) shall be 
     taken into account under this section.
       ``(2) Citizens and residents living abroad.--The dollar 
     amount in effect under subsection (a) (after the application 
     of subsection (b)) shall be decreased by the excess of--
       ``(A) the amounts excluded from the taxpayer's gross income 
     under section 911, over
       ``(B) the amounts of any deductions or exclusions 
     disallowed under section 911(d)(6) with respect to the 
     amounts described in subparagraph (A).
       ``(3) Charitable trusts.--Subsection (a) shall not apply to 
     a trust all the unexpired interests in which are devoted to 
     one or more of the purposes described in section 
     170(c)(2)(B).
       ``(4) Not treated as tax imposed by this chapter for 
     certain purposes.--The tax imposed under this section shall 
     not be treated as tax imposed by this chapter for purposes of 
     determining the amount of any credit under this chapter or 
     for purposes of section 55.''.
       (2) Clerical amendment.--The table of parts for subchapter 
     A of chapter 1 of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new item:

         ``part viii. surcharge on high income individuals.''.

       (3) Section 15 not to apply.--The amendment made by 
     subsection (a) shall not be treated as a change in a rate of 
     tax for purposes of section 15 of the Internal Revenue Code 
     of 1986.
       (4) Effective date.--The amendments made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2010.
                                 ______
                                 
  SA 2844. Mr. SANDERS (for himself and Mr. Brown) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       Beginning on page 1979, line 20, strike all through page 
     1996, line 3, and insert the following:

     SEC. 9001. SURCHARGE ON HIGH INCOME INDIVIDUALS.

       (a) In General.--Subchapter A of chapter 1 of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new part:

           ``PART VIII--SURCHARGE ON HIGH INCOME INDIVIDUALS

``Sec. 59B. Surcharge on high income individuals.

     ``SEC. 59B. SURCHARGE ON HIGH INCOME INDIVIDUALS.

       ``(a) General Rule.--In the case of a taxpayer other than a 
     corporation, there is hereby imposed (in addition to any 
     other tax imposed by this subtitle) a tax equal to 5.4 
     percent of so much of the modified adjusted gross income of 
     the taxpayer as exceeds $1,000,000.
       ``(b) Taxpayers Not Making a Joint Return.--In the case of 
     any taxpayer other than a taxpayer making a joint return 
     under section 6013 or a surviving spouse (as defined in 
     section 2(a)), subsection (a) shall be applied by 
     substituting `$500,000' for `$1,000,000'.
       ``(c) Modified Adjusted Gross Income.--For purposes of this 
     section, the term `modified adjusted gross income' means 
     adjusted gross income reduced by any deduction (not taken 
     into account in determining adjusted gross income) allowed 
     for investment interest (as defined in section 163(d)). In 
     the case of an estate or trust, adjusted gross income shall 
     be determined as provided in section 67(e).
       ``(d) Special Rules.--
       ``(1) Nonresident alien.--In the case of a nonresident 
     alien individual, only amounts taken into account in 
     connection with the tax imposed under section 871(b) shall be 
     taken into account under this section.
       ``(2) Citizens and residents living abroad.--The dollar 
     amount in effect under subsection (a) (after the application 
     of subsection (b)) shall be decreased by the excess of--
       ``(A) the amounts excluded from the taxpayer's gross income 
     under section 911, over
       ``(B) the amounts of any deductions or exclusions 
     disallowed under section 911(d)(6) with respect to the 
     amounts described in subparagraph (A).
       ``(3) Charitable trusts.--Subsection (a) shall not apply to 
     a trust all the unexpired interests in which are devoted to 
     one or more of the purposes described in section 
     170(c)(2)(B).
       ``(4) Not treated as tax imposed by this chapter for 
     certain purposes.--The tax imposed under this section shall 
     not be treated as tax imposed by this chapter for purposes of 
     determining the amount of any credit under this chapter or 
     for purposes of section 55.''.
       (b) Clerical Amendment.--The table of parts for subchapter 
     A of chapter 1 of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new item:

         ``part viii. surcharge on high income individuals.''.

       (c) Section 15 Not to Apply.--The amendment made by 
     subsection (a) shall not be treated as a change in a rate of 
     tax for purposes of section 15 of the Internal Revenue Code 
     of 1986.
       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2010.
                                 ______
                                 
  SA 2845. Mr. SANDERS (for himself and Mr. Wyden) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 212, line 18, strike ``2017'' and insert ``2014''.
       On page 214, line 12, insert ``, except that the Secretary 
     shall determine such amount on the basis of reasonable 
     estimates until such time as data regarding the experiences 
     of other States become available and if such estimates are 
     determined to be incorrect on the basis of such data, the 
     Secretary shall adjust subsequent payments to correct errors 
     in earlier payments that were based on such estimates'' after 
     ``States''.
       On page 219, strike lines 12 through 20, and insert:
       (e) Term of Waiver.--
       (1) In general.--No waiver under this section may extend 
     over a period of longer than 5 years unless the State 
     requests continuation of such waiver and such request is 
     granted by the Secretary under paragraph (2).
       (2) Approval of request.--A request under paragraph (1) 
     shall be deemed granted unless the Secretary, within 90 days 
     after the date of its submission to the Secretary, either 
     denies such request in writing or informs the State in 
     writing with respect to any additional information which is 
     needed in order to make a final determination with respect to 
     the request. The Secretary may deny such a request only if 
     the Secretary--
       (A) determines that the State plan under the waiver to be 
     continued did not meet the requirements under subsection (b);
       (B) notifies the State in writing of the requirements under 
     subsection (b) that the State plan did not meet and provides 
     to the State the information used by the Secretary in making 
     that determination; and
       (C) provides the State with an opportunity to appeal such 
     determination and provide information as to how such 
     requirements were met.

     The Secretary shall consider any information provided under 
     subparagraph (C) and reconsider its determination under 
     subparagraph (A). The Secretary shall grant the request if 
     the Secretary determines upon reconsideration that the State 
     plan met such requirements.
                                 ______
                                 
  SA 2846. Mr. SANDERS (for himself and Mr. Wyden) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       Strike section 1332 and insert the following:

     SEC. 1332. WAIVER FOR STATE INNOVATION.

       (a) Application.--
       (1) In general.--A State may apply to the Secretary for the 
     waiver of all or any requirements described in paragraph (2) 
     with respect to health insurance coverage within that State 
     for plan years beginning on or after January 1, 2014. Such 
     application shall--
       (A) be filed at such time and in such manner as the 
     Secretary may require;
       (B) contain such information as the Secretary may require, 
     including--
       (i) a comprehensive description of the State legislation 
     and program to implement a plan meeting the requirements for 
     a waiver under this section; and
       (ii) a 10-year budget plan for such plan that is budget 
     neutral for the Federal Government; and

[[Page S12254]]

       (C) provide an assurance that the State has enacted the law 
     described in subsection (b)(2).
       (2) Requirements.--The requirements described in this 
     paragraph with respect to health insurance coverage within 
     the State for plan years beginning on or after January 1, 
     2014, are as follows:
       (A) Part I of subtitle D.
       (B) Part II of subtitle D.
       (C) Section 1402.
       (D) Sections 36B, 4980H, and 5000A of the Internal Revenue 
     Code of 1986.
       (3) Pass through of funding.--With respect to a State 
     waiver under paragraph (1), under which, due to the structure 
     of the State plan, individuals and small employers in the 
     State would not qualify for the premium tax credits, cost-
     sharing reductions, or small business credits under sections 
     36B of the Internal Revenue Code of 1986 or under part I of 
     subtitle E for which they would otherwise be eligible, the 
     Secretary shall provide for an alternative means by which the 
     aggregate amount of such credits or reductions that would 
     have been paid on behalf of participants in the Exchanges 
     established under this title had the State not received such 
     waiver, shall be paid to the State for purposes of 
     implementing the State plan under the waiver. Such amount 
     shall be determined annually by the Secretary, taking into 
     consideration the experience of other States with respect to 
     participation in an Exchange and credits and reductions 
     provided under such provisions to residents of the other 
     States, except that the Secretary shall determine such amount 
     on the basis of reasonable estimates until such time as data 
     regarding the experiences of other States become available 
     and if such estimates are determined to be incorrect on the 
     basis of such data, the Secretary shall adjust subsequent 
     payments to correct errors in earlier payments that were 
     based on such estimates.
       (4) Waiver consideration and transparency.--
       (A) In general.--An application for a waiver under this 
     section shall be considered by the Secretary in accordance 
     with the regulations described in subparagraph (B).
       (B) Regulations.--Not later than 180 days after the date of 
     enactment of this Act, the Secretary shall promulgate 
     regulations relating to waivers under this section that 
     provide--
       (i) a process for public notice and comment at the State 
     level, including public hearings, sufficient to ensure a 
     meaningful level of public input;
       (ii) a process for the submission of an application that 
     ensures the disclosure of--

       (I) the provisions of law that the State involved seeks to 
     waive; and
       (II) the specific plans of the State to ensure that the 
     waiver will be in compliance with subsection (b);

       (iii) a process for providing public notice and comment 
     after the application is received by the Secretary, that is 
     sufficient to ensure a meaningful level of public input and 
     that does not impose requirements that are in addition to, or 
     duplicative of, requirements imposed under the Administrative 
     Procedures Act, or requirements that are unreasonable or 
     unnecessarily burdensome with respect to State compliance;
       (iv) a process for the submission to the Secretary of 
     periodic reports by the State concerning the implementation 
     of the program under the waiver; and
       (v) a process for the periodic evaluation by the Secretary 
     of the program under the waiver.
       (C) Report.--The Secretary shall annually report to 
     Congress concerning actions taken by the Secretary with 
     respect to applications for waivers under this section.
       (5) Coordinated waiver process.--The Secretary shall 
     develop a process for coordinating and consolidating the 
     State waiver processes applicable under the provisions of 
     this section, and the existing waiver processes applicable 
     under titles XVIII, XIX, and XXI of the Social Security Act, 
     and any other Federal law relating to the provision of health 
     care items or services. Such process shall permit a State to 
     submit a single application for a waiver under any or all of 
     such provisions.
       (6) Definition.--In this section, the term ``Secretary'' 
     means--
       (A) the Secretary of Health and Human Services with respect 
     to waivers relating to the provisions described in 
     subparagraph (A) through (C) of paragraph (2); and
       (B) the Secretary of the Treasury with respect to waivers 
     relating to the provisions described in paragraph (2)(D).
       (b) Granting of Waivers.--
       (1) In general.--The Secretary may grant a request for a 
     waiver under subsection (a)(1) only if the Secretary 
     determines that the State plan--
       (A) will provide coverage that is at least as comprehensive 
     as the coverage defined in section 1302(b) and offered 
     through Exchanges established under this title as certified 
     by Office of the Actuary of the Centers for Medicare & 
     Medicaid Services based on sufficient data from the State and 
     from comparable States about their experience with programs 
     created by this Act and the provisions of this Act that would 
     be waived;
       (B) will provide coverage and cost sharing protections 
     against excessive out-of-pocket spending that are at least as 
     affordable as the provisions of this title would provide;
       (C) will provide coverage to at least a comparable number 
     of its residents as the provisions of this title would 
     provide; and
       (D) will not increase the Federal deficit.
       (2) Requirement to enact a law.--
       (A) In general.--A law described in this paragraph is a 
     State law that provides for State actions under a waiver 
     under this section, including the implementation of the State 
     plan under subsection (a)(1)(B).
       (B) Termination of opt out.--A State may repeal a law 
     described in subparagraph (A) and terminate the authority 
     provided under the waiver with respect to the State.
       (c) Scope of Waiver.--
       (1) In general.--The Secretary shall determine the scope of 
     a waiver of a requirement described in subsection (a)(2) 
     granted to a State under subsection (a)(1).
       (2) Limitation.--The Secretary may not waive under this 
     section any Federal law or requirement that is not within the 
     authority of the Secretary.
       (d) Determinations by Secretary.--
       (1) Time for determination.--The Secretary shall make a 
     determination under subsection (a)(1) not later than 180 days 
     after the receipt of an application from a State under such 
     subsection.
       (2) Effect of determination.--
       (A) Granting of waivers.--If the Secretary determines to 
     grant a waiver under subsection (a)(1), the Secretary shall 
     notify the State involved of such determination and the terms 
     and effectiveness of such waiver.
       (B) Denial of waiver.--If the Secretary determines a waiver 
     should not be granted under subsection (a)(1), the Secretary 
     shall notify the State involved, and the appropriate 
     committees of Congress of such determination and the reasons 
     therefore.
       (e) Term of Waiver.--
       (1) In general.--No waiver under this section may extend 
     over a period of longer than 5 years unless the State 
     requests continuation of such waiver and such request is 
     granted by the Secretary under paragraph (2).
       (2) Approval of request.--A request under paragraph (1) 
     shall be deemed granted unless the Secretary, within 90 days 
     after the date of its submission to the Secretary, either 
     denies such request in writing or informs the State in 
     writing with respect to any additional information which is 
     needed in order to make a final determination with respect to 
     the request. The Secretary may deny such a request only if 
     the Secretary--
       (A) determines that the State plan under the waiver to be 
     continued did not meet the requirements under subsection (b);
       (B) notifies the State in writing of the requirements under 
     subsection (b) that the State plan did not meet and provides 
     to the State the information used by the Secretary in making 
     that determination; and
       (C) provides the State with an opportunity to appeal such 
     determination and provide information as to how such 
     requirements were met.

     The Secretary shall consider any information provided under 
     subparagraph (C) and reconsider its determination under 
     subparagraph (A). The Secretary shall grant the request if 
     the Secretary determines upon reconsideration that the State 
     plan met such requirements.
                                 ______
                                 
  SA 2847. Mr. SANDERS (for himself and Mr. Wyden) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 212, line 18, strike ``2017'' and insert ``2014''.
                                 ______
                                 
  SA 2848. Mr. SANDERS (for himself and Mr. Wyden) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 214, line 12, insert ``, except that the Secretary 
     shall determine such amount on the basis of reasonable 
     estimates until such time as data regarding the experiences 
     of other States become available and if such estimates are 
     determined to be incorrect on the basis of such data, the 
     Secretary shall adjust subsequent payments to correct errors 
     in earlier payments that were based on such estimates'' after 
     ``States''.
                                 ______
                                 
  SA 2849. Mr. SANDERS (for himself and Mr. Wyden) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 219, strike lines 12 through 20, and insert:

[[Page S12255]]

       (e) Term of Waiver.--
       (1) In general.--No waiver under this section may extend 
     over a period of longer than 5 years unless the State 
     requests continuation of such waiver and such request is 
     granted by the Secretary under paragraph (2).
       (2) Approval of request.--A request under paragraph (1) 
     shall be deemed granted unless the Secretary, within 90 days 
     after the date of its submission to the Secretary, either 
     denies such request in writing or informs the State in 
     writing with respect to any additional information which is 
     needed in order to make a final determination with respect to 
     the request. The Secretary may deny such a request only if 
     the Secretary--
       (A) determines that the State plan under the waiver to be 
     continued did not meet the requirements under subsection (b);
       (B) notifies the State in writing of the requirements under 
     subsection (b) that the State plan did not meet and provides 
     to the State the information used by the Secretary in making 
     that determination; and
       (C) provides the State with an opportunity to appeal such 
     determination and provide information as to how such 
     requirements were met.

     The Secretary shall consider any information provided under 
     subparagraph (C) and reconsider its determination under 
     subparagraph (A). The Secretary shall grant the request if 
     the Secretary determines upon reconsideration that the State 
     plan met such requirements.
                                 ______
                                 
  SA 2850. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title I, add the following:

     SEC. __. REVISION OF EFFECTIVE DATES.

       (a) In General.--Notwithstanding any other provision of 
     this Act (or an amendment made by this Act), this Act shall 
     be implemented by substituting ``2012'' for ``2014'' in each 
     of the following:
       (1) Section 2794 of the Public Health Service Act (as added 
     by section 1003.
       (2) Section 1001.
       (3) Section 1101.
       (4) Section 1002.
       (5) Section 1253.
       (6) Section 1302.
       (7) Section 1311.
       (8) Section 1321.
       (9) Section 1322.
       (10) Section 1332.
       (11) Section 1341.
       (12) Section 36B of the Internal Revenue Code of 1986 (as 
     added by section 1401).
       (13) Section 45R of the Internal Revenue Code of 1986 (as 
     added by section 1421).
       (14) Section 5000A of the Internal Revenue Code of 1986 (as 
     added by section 1501(b)).
       (15) Section 4980H of the Internal Revenue Code of 1986 (as 
     added by section 1513.
       (16) The provisions of title II including the amendments 
     made by such title.
       (b) Surcharge on High Income Individuals.--
       (1) In general.--Subchapter A of chapter 1 of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new part:

           ``PART VIII--SURCHARGE ON HIGH INCOME INDIVIDUALS

``Sec. 59B. Surcharge on high income individuals.

     ``SEC. 59B. SURCHARGE ON HIGH INCOME INDIVIDUALS.

       ``(a) General Rule.--In the case of a taxpayer other than a 
     corporation, there is hereby imposed (in addition to any 
     other tax imposed by this subtitle) a tax equal to 5.4 
     percent of so much of the modified adjusted gross income of 
     the taxpayer as exceeds $1,000,000.
       ``(b) Taxpayers Not Making a Joint Return.--In the case of 
     any taxpayer other than a taxpayer making a joint return 
     under section 6013 or a surviving spouse (as defined in 
     section 2(a)), subsection (a) shall be applied by 
     substituting `$500,000' for `$1,000,000'.
       ``(c) Modified Adjusted Gross Income.--For purposes of this 
     section, the term `modified adjusted gross income' means 
     adjusted gross income reduced by any deduction (not taken 
     into account in determining adjusted gross income) allowed 
     for investment interest (as defined in section 163(d)). In 
     the case of an estate or trust, adjusted gross income shall 
     be determined as provided in section 67(e).
       ``(d) Special Rules.--
       ``(1) Nonresident alien.--In the case of a nonresident 
     alien individual, only amounts taken into account in 
     connection with the tax imposed under section 871(b) shall be 
     taken into account under this section.
       ``(2) Citizens and residents living abroad.--The dollar 
     amount in effect under subsection (a) (after the application 
     of subsection (b)) shall be decreased by the excess of--
       ``(A) the amounts excluded from the taxpayer's gross income 
     under section 911, over
       ``(B) the amounts of any deductions or exclusions 
     disallowed under section 911(d)(6) with respect to the 
     amounts described in subparagraph (A).
       ``(3) Charitable trusts.--Subsection (a) shall not apply to 
     a trust all the unexpired interests in which are devoted to 
     one or more of the purposes described in section 
     170(c)(2)(B).
       ``(4) Not treated as tax imposed by this chapter for 
     certain purposes.--The tax imposed under this section shall 
     not be treated as tax imposed by this chapter for purposes of 
     determining the amount of any credit under this chapter or 
     for purposes of section 55.''.
       (2) Clerical amendment.--The table of parts for subchapter 
     A of chapter 1 of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new item:

         ``part viii. surcharge on high income individuals.''.

       (3) Section 15 not to apply.--The amendment made by 
     paragraph (1) shall not be treated as a change in a rate of 
     tax for purposes of section 15 of the Internal Revenue Code 
     of 1986.
       (4) Effective date.--The amendments made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2010.
                                 ______
                                 
  SA 2851. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title I, add the following:

     SEC. __. REVISION OF EFFECTIVE DATES.

       Notwithstanding any other provision of this Act (or an 
     amendment made by this Act), this Act shall be implemented by 
     substituting ``2012'' for ``2014'' in each of the following:
       (1) Section 2794 of the Public Health Service Act (as added 
     by section 1003.
       (2) Section 1001.
       (3) Section 1101.
       (4) Section 1002.
       (5) Section 1253.
       (6) Section 1302.
       (7) Section 1311.
       (8) Section 1321.
       (9) Section 1322.
       (10) Section 1332.
       (11) Section 1341.
       (12) Section 36B of the Internal Revenue Code of 1986 (as 
     added by section 1401).
       (13) Section 45R of the Internal Revenue Code of 1986 (as 
     added by section 1421).
       (14) Section 5000A of the Internal Revenue Code of 1986 (as 
     added by section 1501(b)).
       (15) Section 4980H of the Internal Revenue Code of 1986 (as 
     added by section 1513.
       (16) The provisions of title II including the amendments 
     made by such title.
                                 ______
                                 
  SA 2852. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Strike section 2001 and insert the following:

     SEC. 2001. MEDICAID ELIGIBILITY FOR INDIVIDUALS WITH INCOME 
                   BELOW 150 PERCENT OF THE FEDERAL POVERTY LEVEL.

       (a) Eligibility for Non-Traditional Individuals With Income 
     Below 150 Percent of the Federal Poverty Level.--
       (1) Full medicaid benefits for non-medicare eligible 
     individuals.--Section 1902(a)(10)(A)(i) of the Social 
     Security Act (42 U.S.C. 1396b(a)(10)(A)(i)) is amended--
       (A) by striking ``or'' at the end of subclause (VI);
       (B) by adding ``or'' at the end of subclause (VII); and
       (C) by adding at the end the following new subclause:

       ``(VIII) who are under 65 years of age, who are not 
     described in a previous subclause of this clause, who are not 
     entitled to hospital insurance benefits under part A of title 
     XVIII, and whose family income (determined using 
     methodologies and procedures specified by the Secretary ) 
     does not exceed 150 percent of the income official poverty 
     line (as defined by the Office of Management and Budget, and 
     revised annually in accordance with section 673(2) of the 
     Omnibus Budget Reconciliation Act of 1981) applicable to a 
     family of the size involved;''.

       (2) Medicare cost sharing assistance for medicare-eligible 
     individuals.--Section 1902(a)(10)(E) of such Act (42 U.S.C. 
     1396b(a)(10)(E)) is amended--
       (A) in clause (iii), by striking ``and'' at the end;
       (B) in clause (iv), by adding ``and'' at the end; and
       (C) by adding at the end the following new clause:
       ``(v) for making medical assistance available for medicare 
     cost-sharing described in

[[Page S12256]]

     subparagraphs (B) and (C) of section 1905(p)(3), for 
     individuals under 65 years of age who would be qualified 
     medicare beneficiaries described in section 1905(p)(1) but 
     for the fact that their income exceeds the income level 
     established by the State under section 1905(p)(2) but is less 
     than 150 percent of the official poverty line (referred to in 
     such section) for a family of the size involved; and''.
       (3) Increased fmap for non-traditional full medicaid 
     eligible individuals.--Section 1905 of such Act (42 U.S.C. 
     1396d) is amended--
       (A) in the first sentence of subsection (b), by striking 
     ``and'' before ``(4)'' and by inserting before the period at 
     the end the following: ``, and (5) 100 percent (for periods 
     before 2015 and 91 percent for periods beginning with 2015) 
     with respect to amounts described in subsection (y)''; and
       (B) by adding at the end the following new subsection:
       ``(y) Additional Expenditures Subject to Increased FMAP.--
     For purposes of section 1905(b)(5), the amounts described in 
     this subsection are the following:
       ``(1) Amounts expended for medical assistance for 
     individuals described in subclause (VIII) of section 
     1902(a)(10)(A)(i).''.
       (4) Construction.--Nothing in this subsection shall be 
     construed as not providing for coverage under subparagraph 
     (A)(i)(VIII) or (E)(v) of section 1902(a)(10) of the Social 
     Security Act, as added by paragraphs (1) and (2), or an 
     increased FMAP under the amendments made by paragraph (3), 
     for an individual who has been provided medical assistance 
     under title XIX of the Act under a demonstration waiver 
     approved under section 1115 of such Act or with State funds.
       (5) Conforming amendments.--
       (A) Section 1903(f)(4) of the Social Security Act (42 
     U.S.C. 1396b(f)(4)) is amended--
       (i) by inserting ``1902(a)(10)(A)(i)(VIII),'' after 
     ``1902(a)(10)(A)(i)(VII),''; and
       (ii) by inserting ``1902(a)(10)(E)(v),'' before 
     ``1905(p)(1)''.
       (B) Section 1905(a) of such Act (42 U.S.C. 1396d(a)), is 
     amended, in the matter preceding paragraph (1)--
       (i) by striking ``or'' at the end of clause (xii);
       (ii) by adding ``or'' at the end of clause (xiii); and
       (iii) by inserting after clause (xiii) the following:
       ``(xiv) individuals described in section 
     1902(a)(10)(A)(i)(VIII),''.
       (b) Eligibility for Traditional Medicaid Eligible 
     Individuals With Income Not Exceeding 150 Percent of the 
     Federal Poverty Level .--
       (1) In general.--Section 1902(a)(10)(A)(i) of the Social 
     Security Act (42 U.S.C. 1396b(a)(10)(A)(i)), as amended by 
     subsection (a), is amended--
       (A) by striking ``or'' at the end of subclause (VII); and
       (B) by adding at the end the following new subclauses:

       ``(IX) who are over 18, and under 65 years of age, who 
     would be eligible for medical assistance under the State plan 
     under subclause (I) or section 1931 (based on the income 
     standards, methodologies, and procedures in effect as of June 
     16, 2009) but for income, who are in families whose income 
     does not exceed 150 percent of the income official poverty 
     line (as defined by the Office of Management and Budget, and 
     revised annually in accordance with section 673(2) of the 
     Omnibus Budget Reconciliation Act of 1981) applicable to a 
     family of the size involved; or
       ``(X) beginning with 2014, who are under 19, years of age, 
     who would be eligible for medical assistance under the State 
     plan under subclause (I), (IV) (insofar as it relates to 
     subsection (l)(1)(B)), (VI), or (VII) (based on the income 
     standards, methodologies, and procedures in effect as of June 
     16, 2009) but for income, who are in families whose income 
     does not exceed 150 percent of the income official poverty 
     line (as defined by the Office of Management and Budget, and 
     revised annually in accordance with section 673(2) of the 
     Omnibus Budget Reconciliation Act of 1981) applicable to a 
     family of the size involved; or''.

       (2) Increased fmap for certain traditional medicaid 
     eligible individuals.--
       (A) Increased fmap for adults.--Section 1905(y) of such Act 
     (42 U.S.C. 1396d(y)), as added by subsection (a)(2)(B), is 
     amended by inserting ``or (IX)'' after ``(VIII)''.
       (B) Enhanced fmap for children.--Section 1905(b)(4) of such 
     Act is amended by inserting ``1902(a)(10)(A)(i)(X), or'' 
     after ``on the basis of section''.
       (3) Construction.--Nothing in this subsection shall be 
     construed as not providing for coverage under subclause (IX) 
     or (X) of section 1902(a)(10)(A)(i) of the Social Security 
     Act, as added by paragraph (1), or an increased or enhanced 
     FMAP under the amendments made by paragraph (2), for an 
     individual who has been provided medical assistance under 
     title XIX of the Act under a demonstration waiver approved 
     under section 1115 of such Act or with State funds.
       (4) Conforming amendment.--Section 1903(f)(4) of the Social 
     Security Act (42 U.S.C. 1396b(f)(4)), as amended by 
     subsection (a)(4), is amended by inserting 
     ``1902(a)(10)(A)(i)(IX), 1902(a)(10)(A)(i)(X),'' after 
     ``1902(a)(10)(A)(i)(VIII),''.
       (c) Network Adequacy.--Section 1932(a)(2) of the Social 
     Security Act (42 U.S.C. 1396u-2(a)(2)) is amended by adding 
     at the end the following new subparagraph:
       ``(D) Enrollment of non-traditional medicaid eligibles.--A 
     State may not require under paragraph (1) the enrollment in a 
     managed care entity of an individual described in section 
     1902(a)(10)(A)(i)(VIII) unless the State demonstrates, to the 
     satisfaction of the Secretary, that the entity, through its 
     provider network and other arrangements, has the capacity to 
     meet the health, mental health, and substance abuse needs of 
     such individuals.''.
       (d) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 2013, and shall apply with 
     respect to items and services furnished on or after such 
     date.
       (e) Definitions.--In this section:
       (1) Medicaid eligible individual.--The term ``Medicaid 
     eligible individual'' means an individual who is eligible for 
     medical assistance under Medicaid.
       (2) Traditional medicaid eligible individual.--The term 
     ``traditional Medicaid eligible individual'' means a Medicaid 
     eligible individual other than an individual who is--
       (A) a Medicaid eligible individual by rea1son of the 
     application of subclause (VIII) of section 1902(a)(10)(A)(i) 
     of the Social Security Act; or
       (B) a childless adult not described in section 
     1902(a)(10)(A) or (C) of such Act (as in effect as of the day 
     before the date of the enactment of this Act).
       (3) Non-traditional medicaid eligible individual.--The term 
     ``non-traditional Medicaid eligible individual'' means a 
     Medicaid eligible individual who is not a traditional 
     Medicaid eligible individual.
                                 ______
                                 
  SA 2853. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:
       Strike section 2001 and insert the following:

     SEC. 2001. MEDICAID ELIGIBILITY FOR INDIVIDUALS WITH INCOME 
                   BELOW 150 PERCENT OF THE FEDERAL POVERTY LEVEL.

       (a) Eligibility for Non-Traditional Individuals With Income 
     Below 150 Percent of the Federal Poverty Level.--
       (1) Full medicaid benefits for non-medicare eligible 
     individuals.--Section 1902(a)(10)(A)(i) of the Social 
     Security Act (42 U.S.C. 1396b(a)(10)(A)(i)) is amended--
       (A) by striking ``or'' at the end of subclause (VI);
       (B) by adding ``or'' at the end of subclause (VII); and
       (C) by adding at the end the following new subclause:

       ``(VIII) who are under 65 years of age, who are not 
     described in a previous subclause of this clause, who are not 
     entitled to hospital insurance benefits under part A of title 
     XVIII, and whose family income (determined using 
     methodologies and procedures specified by the Secretary ) 
     does not exceed 150 percent of the income official poverty 
     line (as defined by the Office of Management and Budget, and 
     revised annually in accordance with section 673(2) of the 
     Omnibus Budget Reconciliation Act of 1981) applicable to a 
     family of the size involved;''.

       (2) Medicare cost sharing assistance for medicare-eligible 
     individuals.--Section 1902(a)(10)(E) of such Act (42 U.S.C. 
     1396b(a)(10)(E)) is amended--
       (A) in clause (iii), by striking ``and'' at the end;
       (B) in clause (iv), by adding ``and'' at the end; and
       (C) by adding at the end the following new clause:
       ``(v) for making medical assistance available for medicare 
     cost-sharing described in subparagraphs (B) and (C) of 
     section 1905(p)(3), for individuals under 65 years of age who 
     would be qualified medicare beneficiaries described in 
     section 1905(p)(1) but for the fact that their income exceeds 
     the income level established by the State under section 
     1905(p)(2) but is less than 150 percent of the official 
     poverty line (referred to in such section) for a family of 
     the size involved; and''.
       (3) Increased fmap for non-traditional full medicaid 
     eligible individuals.--Section 1905 of such Act (42 U.S.C. 
     1396d) is amended--
       (A) in the first sentence of subsection (b), by striking 
     ``and'' before ``(4)'' and by inserting before the period at 
     the end the following: ``, and (5) 100 percent (for periods 
     before 2015 and 91 percent for periods beginning with 2015) 
     with respect to amounts described in subsection (y)''; and
       (B) by adding at the end the following new subsection:
       ``(y) Additional Expenditures Subject to Increased FMAP.--
     For purposes of section 1905(b)(5), the amounts described in 
     this subsection are the following:
       ``(1) Amounts expended for medical assistance for 
     individuals described in subclause (VIII) of section 
     1902(a)(10)(A)(i).''.
       (4) Construction.--Nothing in this subsection shall be 
     construed as not providing for coverage under subparagraph 
     (A)(i)(VIII) or (E)(v) of section 1902(a)(10) of the Social 
     Security Act, as added by paragraphs (1) and

[[Page S12257]]

     (2), or an increased FMAP under the amendments made by 
     paragraph (3), for an individual who has been provided 
     medical assistance under title XIX of the Act under a 
     demonstration waiver approved under section 1115 of such Act 
     or with State funds.
       (5) Conforming amendments.--
       (A) Section 1903(f)(4) of the Social Security Act (42 
     U.S.C. 1396b(f)(4)) is amended--
       (i) by inserting ``1902(a)(10)(A)(i)(VIII),'' after 
     ``1902(a)(10)(A)(i)(VII),''; and
       (ii) by inserting ``1902(a)(10)(E)(v),'' before 
     ``1905(p)(1)''.
       (B) Section 1905(a) of such Act (42 U.S.C. 1396d(a)), is 
     amended, in the matter preceding paragraph (1)--
       (i) by striking ``or'' at the end of clause (xii);
       (ii) by adding ``or'' at the end of clause (xiii); and
       (iii) by inserting after clause (xiii) the following:
       ``(xiv) individuals described in section 
     1902(a)(10)(A)(i)(VIII),''.
       (b) Eligibility for Traditional Medicaid Eligible 
     Individuals With Income Not Exceeding 150 Percent of the 
     Federal Poverty Level .--
       (1) In general.--Section 1902(a)(10)(A)(i) of the Social 
     Security Act (42 U.S.C. 1396b(a)(10)(A)(i)), as amended by 
     subsection (a), is amended--
       (A) by striking ``or'' at the end of subclause (VII); and
       (B) by adding at the end the following new subclauses:

       ``(IX) who are over 18, and under 65 years of age, who 
     would be eligible for medical assistance under the State plan 
     under subclause (I) or section 1931 (based on the income 
     standards, methodologies, and procedures in effect as of June 
     16, 2009) but for income, who are in families whose income 
     does not exceed 150 percent of the income official poverty 
     line (as defined by the Office of Management and Budget, and 
     revised annually in accordance with section 673(2) of the 
     Omnibus Budget Reconciliation Act of 1981) applicable to a 
     family of the size involved; or
       ``(X) beginning with 2014, who are under 19, years of age, 
     who would be eligible for medical assistance under the State 
     plan under subclause (I), (IV) (insofar as it relates to 
     subsection (l)(1)(B)), (VI), or (VII) (based on the income 
     standards, methodologies, and procedures in effect as of June 
     16, 2009) but for income, who are in families whose income 
     does not exceed 150 percent of the income official poverty 
     line (as defined by the Office of Management and Budget, and 
     revised annually in accordance with section 673(2) of the 
     Omnibus Budget Reconciliation Act of 1981) applicable to a 
     family of the size involved; or''.

       (2) Increased fmap for certain traditional medicaid 
     eligible individuals.--
       (A) Increased fmap for adults.--Section 1905(y) of such Act 
     (42 U.S.C. 1396d(y)), as added by subsection (a)(2)(B), is 
     amended by inserting ``or (IX)'' after ``(VIII)''.
       (B) Enhanced fmap for children.--Section 1905(b)(4) of such 
     Act is amended by inserting ``1902(a)(10)(A)(i)(X), or'' 
     after ``on the basis of section''.
       (3) Construction.--Nothing in this subsection shall be 
     construed as not providing for coverage under subclause (IX) 
     or (X) of section 1902(a)(10)(A)(i) of the Social Security 
     Act, as added by paragraph (1), or an increased or enhanced 
     FMAP under the amendments made by paragraph (2), for an 
     individual who has been provided medical assistance under 
     title XIX of the Act under a demonstration waiver approved 
     under section 1115 of such Act or with State funds.
       (4) Conforming amendment.--Section 1903(f)(4) of the Social 
     Security Act (42 U.S.C. 1396b(f)(4)), as amended by 
     subsection (a)(4), is amended by inserting 
     ``1902(a)(10)(A)(i)(IX), 1902(a)(10)(A)(i)(X),'' after 
     ``1902(a)(10)(A)(i)(VIII),''.
       (c) Network Adequacy.--Section 1932(a)(2) of the Social 
     Security Act (42 U.S.C. 1396u-2(a)(2)) is amended by adding 
     at the end the following new subparagraph:
       ``(D) Enrollment of non-traditional medicaid eligibles.--A 
     State may not require under paragraph (1) the enrollment in a 
     managed care entity of an individual described in section 
     1902(a)(10)(A)(i)(VIII) unless the State demonstrates, to the 
     satisfaction of the Secretary, that the entity, through its 
     provider network and other arrangements, has the capacity to 
     meet the health, mental health, and substance abuse needs of 
     such individuals.''.
       (d) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 2013, and shall apply with 
     respect to items and services furnished on or after such 
     date.
       (e) Definitions.--In this section:
       (1) Medicaid eligible individual.--The term ``Medicaid 
     eligible individual'' means an individual who is eligible for 
     medical assistance under Medicaid.
       (2) Traditional medicaid eligible individual.--The term 
     ``traditional Medicaid eligible individual'' means a Medicaid 
     eligible individual other than an individual who is--
       (A) a Medicaid eligible individual by rea1son of the 
     application of subclause (VIII) of section 1902(a)(10)(A)(i) 
     of the Social Security Act; or
       (B) a childless adult not described in section 
     1902(a)(10)(A) or (C) of such Act (as in effect as of the day 
     before the date of the enactment of this Act).
       (3) Non-traditional medicaid eligible individual.--The term 
     ``non-traditional Medicaid eligible individual'' means a 
     Medicaid eligible individual who is not a traditional 
     Medicaid eligible individual.

     SEC. 2001A. SURCHARGE ON HIGH INCOME INDIVIDUALS.

       (a) In General.--Subchapter A of chapter 1 of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new part:

           ``PART VIII--SURCHARGE ON HIGH INCOME INDIVIDUALS

``Sec. 59B. Surcharge on high income individuals.

     ``SEC. 59B. SURCHARGE ON HIGH INCOME INDIVIDUALS.

       ``(a) General Rule.--In the case of a taxpayer other than a 
     corporation, there is hereby imposed (in addition to any 
     other tax imposed by this subtitle) a tax equal to 5.4 
     percent of so much of the modified adjusted gross income of 
     the taxpayer as exceeds $1,000,000.
       ``(b) Taxpayers Not Making a Joint Return.--In the case of 
     any taxpayer other than a taxpayer making a joint return 
     under section 6013 or a surviving spouse (as defined in 
     section 2(a)), subsection (a) shall be applied by 
     substituting `$500,000' for `$1,000,000'.
       ``(c) Modified Adjusted Gross Income.--For purposes of this 
     section, the term `modified adjusted gross income' means 
     adjusted gross income reduced by any deduction (not taken 
     into account in determining adjusted gross income) allowed 
     for investment interest (as defined in section 163(d)). In 
     the case of an estate or trust, adjusted gross income shall 
     be determined as provided in section 67(e).
       ``(d) Special Rules.--
       ``(1) Nonresident alien.--In the case of a nonresident 
     alien individual, only amounts taken into account in 
     connection with the tax imposed under section 871(b) shall be 
     taken into account under this section.
       ``(2) Citizens and residents living abroad.--The dollar 
     amount in effect under subsection (a) (after the application 
     of subsection (b)) shall be decreased by the excess of--
       ``(A) the amounts excluded from the taxpayer's gross income 
     under section 911, over
       ``(B) the amounts of any deductions or exclusions 
     disallowed under section 911(d)(6) with respect to the 
     amounts described in subparagraph (A).
       ``(3) Charitable trusts.--Subsection (a) shall not apply to 
     a trust all the unexpired interests in which are devoted to 
     one or more of the purposes described in section 
     170(c)(2)(B).
       ``(4) Not treated as tax imposed by this chapter for 
     certain purposes.--The tax imposed under this section shall 
     not be treated as tax imposed by this chapter for purposes of 
     determining the amount of any credit under this chapter or 
     for purposes of section 55.''.
       (b) Clerical Amendment.--The table of parts for subchapter 
     A of chapter 1 of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new item:

         ``part viii. surcharge on high income individuals.''.

       (c) Section 15 Not to Apply.--The amendment made by 
     subsection (a) shall not be treated as a change in a rate of 
     tax for purposes of section 15 of the Internal Revenue Code 
     of 1986.
       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2010.
                                 ______
                                 
  SA 2854. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 103, line 10, insert before the period the 
     following: ``, including oral and vision care''.

                                 ______
                                 
  SA 2855. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title I, insert the following:

     SEC. __. ORAL AND VISION CARE.

       (a) Technical Amendment.--Section 1302(b)(1)(A) of this Act 
     is amended by inserting ``, including oral and vision care'' 
     before the period.
       (b) Surcharge on High Income Individuals.--
       (1) In general.--Subchapter A of chapter 1 of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new part:

           ``PART VIII--SURCHARGE ON HIGH INCOME INDIVIDUALS

``Sec. 59B. Surcharge on high income individuals.

[[Page S12258]]

     ``SEC. 59B. SURCHARGE ON HIGH INCOME INDIVIDUALS.

       ``(a) General Rule.--In the case of a taxpayer other than a 
     corporation, there is hereby imposed (in addition to any 
     other tax imposed by this subtitle) a tax equal to 5.4 
     percent of so much of the modified adjusted gross income of 
     the taxpayer as exceeds $1,000,000.
       ``(b) Taxpayers Not Making a Joint Return.--In the case of 
     any taxpayer other than a taxpayer making a joint return 
     under section 6013 or a surviving spouse (as defined in 
     section 2(a)), subsection (a) shall be applied by 
     substituting `$500,000' for `$1,000,000'.
       ``(c) Modified Adjusted Gross Income.--For purposes of this 
     section, the term `modified adjusted gross income' means 
     adjusted gross income reduced by any deduction (not taken 
     into account in determining adjusted gross income) allowed 
     for investment interest (as defined in section 163(d)). In 
     the case of an estate or trust, adjusted gross income shall 
     be determined as provided in section 67(e).
       ``(d) Special Rules.--
       ``(1) Nonresident alien.--In the case of a nonresident 
     alien individual, only amounts taken into account in 
     connection with the tax imposed under section 871(b) shall be 
     taken into account under this section.
       ``(2) Citizens and residents living abroad.--The dollar 
     amount in effect under subsection (a) (after the application 
     of subsection (b)) shall be decreased by the excess of--
       ``(A) the amounts excluded from the taxpayer's gross income 
     under section 911, over
       ``(B) the amounts of any deductions or exclusions 
     disallowed under section 911(d)(6) with respect to the 
     amounts described in subparagraph (A).
       ``(3) Charitable trusts.--Subsection (a) shall not apply to 
     a trust all the unexpired interests in which are devoted to 
     one or more of the purposes described in section 
     170(c)(2)(B).
       ``(4) Not treated as tax imposed by this chapter for 
     certain purposes.--The tax imposed under this section shall 
     not be treated as tax imposed by this chapter for purposes of 
     determining the amount of any credit under this chapter or 
     for purposes of section 55.''.
       (2) Clerical amendment.--The table of parts for subchapter 
     A of chapter 1 of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new item:

         ``part viii. surcharge on high income individuals.''.

       (3) Section 15 not to apply.--The amendment made by 
     paragraph (1) shall not be treated as a change in a rate of 
     tax for purposes of section 15 of the Internal Revenue Code 
     of 1986.
       (4) Effective date.--The amendments made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2010.
                                 ______
                                 
  SA 2856. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 97, between lines 6 and 7, insert the following:

     SEC. 2709. APPLICATION OF PREMIUM AND COVERAGE RULES TO 
                   GRANDFATHERED GROUP PLANS AND OTHER LARGE GROUP 
                   PLANS.

       Notwithstanding section 2701 or 2707, or section 1251 of 
     the Patient Protection and Affordable Care Act, in the case 
     of plan years beginning after December 31, 2014, sections 
     2701 and 2707 shall apply to a group health plan, and a 
     health insurance issuer offering group health insurance 
     coverage, which is--
       (1) a grandfathered health plan (as defined in section 
     1251(e) of such Act); or
       (2) health insurance coverage offered in the large group 
     market.
                                 ______
                                 
  SA 2857. Mr. SANDERS submitted an amendment intended t be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 162, after line 25, add the following:
       (7) Cap on private insurance company executive 
     compensation.--
       (A) Limits on compensation for executives of private 
     insurance companies participating in an exchange.--
       (i) In general.--Notwithstanding any other provision of law 
     or agreement to the contrary, no employee or executive of a 
     private health insurance issuer that offers coverage through 
     an Exchange may receive aggregate annual compensation, in any 
     form, from the issuer in an amount in excess of $1,000,000.
       (ii) Definition.--For purposes of this paragraph, the term 
     ``aggregate annual compensation'' includes bonuses, deferred 
     compensation, stock options, securities, or any other form of 
     compensation provided to an employee or executive.
       (B) Bar from participation in exchange.--If a private 
     health insurance issuer offering coverage through an Exchange 
     fails to comply with the requirement of subparagraph (A), 
     such issuer shall be prohibited from offering coverage 
     through the Exchange.
                                 ______
                                 
  SA 2858. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for Mr. Baucus. Mr. Dodd, 
and Mr. Harkin) to the bill H.R. 3590, to amend the Internal Revenue 
Code of 1986 to modify the first-time homebuyers credit in the case of 
members of the Armed Forces and certain other Federal employees, and 
for other purposes; which was ordered to lie on the table; as follows:

       On page 1925, between lines 14 and 15, insert the 
     following:

        Subtitle C--Ethical Pathway for Pharmaceutical Products

     SEC. 7201. ETHICAL PATHWAY FOR THE APPROVAL AND LICENSURE OF 
                   GENERIC PHARMACEUTICAL PRODUCTS.

       (a) Definitions.--In this section--
       (1) the term ``abbreviated new drug application'' means an 
     abbreviated application for a new drug submitted under 
     section 505(j) of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 355(j);
       (2) the term ``Commissioner'' means the Commissioner of 
     Food and Drugs; and
       (3) the term ``Secretary'' means the Secretary of Health 
     and Human Services.
       (b) Ethical Pathway.--As soon as practicable after the date 
     of enactment of this Act, the Secretary, acting through the 
     Commissioner, shall establish a mechanism by which the filer 
     of an abbreviated new drug application for approval of a drug 
     or an application for licensure of a biological product under 
     section 351(k) of the Public Health Service Act may request a 
     cost-sharing arrangement described in subsection (c). Such a 
     filer may request such an arrangement if, but for the 
     arrangement, such filer would be required to conduct clinical 
     investigations involving human subjects that violate Article 
     20 of the Declaration of Helsinki on Ethical Principles for 
     Medical Research Involving Human Subjects in order to obtain 
     such approval or licensure from the Secretary.
       (c) Cost-Sharing Arrangement.--The cost-sharing arrangement 
     described in this subsection is an arrangement in which--
       (1) the filer of the abbreviated new drug application or 
     the application under section 351(k) of the Public Health 
     Service Act pays a fee to the Commissioner;
       (2) notwithstanding any other provision of law, the 
     Commissioner provides such reports to such filer;
       (3) such filer may, notwithstanding any provision of 
     chapter V of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 351 et seq.) or of the Public Health Service Act (42 
     U.S.C. 301 et seq.), rely in such application on reports of 
     investigations, conducted by a holder of an approved 
     application under section 505(b) of the Federal Food, Drug, 
     and Cosmetic Act or a holder of a license under section 
     351(a) of the Public Health Service Act, which have been made 
     to show whether or not such drug or biological product is 
     safe for use and whether such drug or biological product is 
     effective in use; and
       (4) the Commissioner remits the amount of such fee to the 
     holder of the approved application under such section 505(b) 
     or of the license under such section 351(a), as appropriate.
                                 ______
                                 
  SA 2859. Ms. SNOWE (for herself, Ms. Landrieu, and Mrs. Lincoln) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 223, strike lines 6 through 10.
       On page 224, line 2, insert after ``Act'' the following: 
     ``, including the rating requirements of such part A (except 
     that the State may subsequent to the date of enactment of 
     this Act enact more restrictive rating requirements),''.

                          ____________________