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

  Subtitle A--Modernizing Disease Prevention and Public Health Systems

SEC. 4001. NATIONAL <<NOTE: 42 USC 300u-10.>> PREVENTION, HEALTH 
            PROMOTION AND PUBLIC HEALTH COUNCIL.

    (a) Establishment.--The President <<NOTE: 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 <<NOTE: President. Appointment.>> 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;

[[Page 124 STAT. 539]]

            (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 <<NOTE: President.>> Group.--
            (1) In general.--The <<NOTE: Establishment.>> 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

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                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 <<NOTE: Deadline. Public information.>> later than 1 year after the 
date of enactment of this Act, the Chairperson, in consultation with the 
Council, shall develop and make public a national prevention, health 
promotion and public health strategy, and shall review and revise such 
strategy periodically. Such strategy shall--
            (1) set specific goals and objectives for improving the 
        health of the United States through federally-supported 
        prevention, health promotion, and public health programs, 
        consistent with ongoing goal setting efforts conducted by 
        specific agencies;
            (2) establish specific and measurable actions and timelines 
        to carry out the strategy, and determine accountability for 
        meeting those timelines, within and across Federal departments 
        and agencies; and
            (3) make recommendations to improve Federal efforts relating 
        to prevention, health promotion, public health, and integrative 
        health care practices to ensure Federal efforts are consistent 
        with available standards and evidence.

    (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

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        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 <<NOTE: Deadlines. Evaluations.>> 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 <<NOTE: Web 
posting.>> reviews shall be evaluated based on effectiveness in meeting 
metrics-based goals with an analysis posted on such agencies' public 
Internet websites.

SEC. 4002. PREVENTION <<NOTE: 42 USC 300u-11.>> 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. 4003. 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

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        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.

[[Page 124 STAT. 543]]

            ``(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 <<NOTE: 42 USC 280g-10.>> 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 <<NOTE: Review. Recommenda- tions. Publication.>> Task Force shall 
review the scientific evidence related to the effectiveness, 
appropriateness, and cost-effectiveness of community preventive 
interventions for the purpose of developing recommendations, to be 
published in the Guide to Community Preventive Services (referred to in 
this section as the `Guide'), for individuals and organizations 
delivering population-based services, including primary care 
professionals, health care systems, professional societies, employers, 
community organizations, non-profit organizations, schools, governmental 
public health agencies, Indian tribes, tribal organizations and urban 
Indian organizations, medical groups, Congress and other policy-makers. 
Community preventive services include any policies, programs, processes 
or activities designed to affect or otherwise affecting health at the 
population level.

    ``(b) Duties.--The duties of the Task Force shall include--
            ``(1) the development of additional topic areas for new 
        recommendations and interventions related to those topic areas, 
        including those related to specific populations and age groups, 
        as well as the social, economic and physical environments that 
        can have broad effects on the health and disease of populations 
        and health disparities among sub-populations and age groups;
            ``(2) at least once during every 5-year period, review 
        interventions and update recommendations related to existing 
        topic areas, including new or improved techniques to assess the 
        health effects of interventions, including health impact 
        assessment and population health modeling;
            ``(3) improved integration with Federal Government health 
        objectives and related target setting for health improvement;
            ``(4) the enhanced dissemination of recommendations;
            ``(5) the provision of technical assistance to those health 
        care professionals, agencies, and organizations that request 
        help in implementing the Guide recommendations; and
            ``(6) providing yearly reports to Congress and related 
        agencies identifying gaps in research and recommending priority 
        areas that deserve further examination, including areas related

[[Page 124 STAT. 544]]

        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)) <<NOTE: 42 USC 280g-
                7.>> is redesignated as section 399S.
                    (B) Section 399R of such Act (as added by section 3 
                of the Prenatally and Postnatally Diagnosed Conditions 
                Awareness <<NOTE: 42 USC 280g-8.>> Act (Public Law 110-
                374; 122 Stat. 4051)) is redesignated as section 399T.

SEC. 4004. EDUCATION <<NOTE: 42 USC 300u-12.>> AND OUTREACH CAMPAIGN 
            REGARDING PREVENTIVE BENEFITS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall provide for the 
planning and implementation of a national public-private partnership for 
a prevention and health promotion outreach and education campaign to 
raise public awareness of health improvement across the life span. Such 
campaign shall include the dissemination of information that--
            (1) describes the importance of utilizing preventive 
        services to promote wellness, reduce health disparities, and 
        mitigate chronic disease;
            (2) promotes the use of preventive services recommended by 
        the United States Preventive Services Task Force and the 
        Community Preventive Services Task Force;
            (3) encourages healthy behaviors linked to the prevention of 
        chronic diseases;
            (4) explains the preventive services covered under health 
        plans offered through a Gateway;
            (5) describes additional preventive care supported by the 
        Centers for Disease Control and Prevention, the Health Resources 
        and Services Administration, the Substance Abuse and Mental 
        Health Services Administration, the Advisory Committee on 
        Immunization Practices, and other appropriate agencies; and
            (6) includes general health promotion information.

[[Page 124 STAT. 545]]

    (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 <<NOTE: Deadline.>> 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 <<NOTE: Deadlines. Reports.>> 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 <<NOTE: Plan.>> Information Through 
Providers.--The Secretary, acting through the Centers for Disease 
Control and Prevention, shall develop and implement a plan for the 
dissemination of health promotion and disease prevention information 
consistent with national priorities, to health care providers who 
participate in Federal programs, including programs administered by the 
Indian Health Service, the Department of Veterans Affairs, the 
Department of Defense, and the Health Resources and Services 
Administration, and Medicare and Medicaid.

    (f) Personalized Prevention Plans.--
            (1) Contract.--The Secretary, <<NOTE: Web site.>> 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

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        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 to Medicaid 
        enrollees, including obesity screening and counseling for 
        children and adults.
            (2) Information to enrollees.--Each State shall design a 
        public awareness campaign to educate Medicaid enrollees 
        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. 4101. SCHOOL-BASED HEALTH CENTERS.

    (a) Grants <<NOTE: 42 USC 280h-4.>> 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

[[Page 124 STAT. 547]]

                any service that is not authorized or allowed by 
                Federal, State, or local law.
            (3) Preference.--In awarding grants under this section, the 
        Secretary shall give preference to awarding grants for school-
        based health centers that serve a large population of children 
        eligible for medical assistance under the State Medicaid plan 
        under title XIX of the Social Security Act or under a waiver of 
        such plan or children eligible for child health assistance under 
        the State child health plan under title XXI of that Act (42 
        U.S.C. 1397aa et seq.).
            (4) 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.
            (5) 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.
            (6) 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. 280h et seq.) 
is amended by adding at the end the following:

``SEC. 399Z-1. <<NOTE: 42 USC 280h-5.>> 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

[[Page 124 STAT. 548]]

                services for medically underserved children and 
                adolescents under subparagraph (A) that shall--
                          ``(i) take into account any comments received 
                      by the Secretary from the chief executive officer 
                      of a State and local officials in a State; and
                          ``(ii) include factors indicative of the 
                      health status of such children and adolescents of 
                      an area, including the ability of the residents of 
                      such area to pay for health services, the 
                      accessibility of such services, the availability 
                      of health professionals to such children and 
                      adolescents, and other factors as determined 
                      appropriate by the Secretary.
            ``(3) School-based health 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,

[[Page 124 STAT. 549]]

                      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) Communities with high per capita numbers of 
                children and adolescents who are uninsured, 
                underinsured, or enrolled in public health insurance 
                programs.
                    ``(C) 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 
        4101 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,

[[Page 124 STAT. 550]]

        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. 4102. ORAL HEALTHCARE PREVENTION ACTIVITIES.

    (a) In General.--Title III of the Public Health Service Act (42 
U.S.C. 241 et seq.), as amended by section 3025, is amended by adding at 
the end the following:

             ``PART T--ORAL HEALTHCARE PREVENTION ACTIVITIES

``SEC. 399LL. ORAL <<NOTE: 42 USC 280k.>> 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

[[Page 124 STAT. 551]]

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 <<NOTE: Deadline.>> than 2 years after the date of enactment of 
this section, the Secretary shall begin implementing the 5-year 
campaign. During the 2-year period referred to in the previous sentence, 
the Secretary shall conduct planning activities with respect to the 
campaign.

``SEC. 399LL-1. RESEARCH-BASED <<NOTE: Grants. 42 USC 280k-1.>> 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 <<NOTE: Submission.>> 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 <<NOTE: 42 USC 280k-2.>> 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

[[Page 124 STAT. 552]]

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 <<NOTE: 42 USC 280k-3.>> 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 <<NOTE: Deadline.>> components shall be updated by the 
        Secretary at least every 6 years. 
        For <<NOTE: Definition.>> 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.

[[Page 124 STAT. 553]]

            (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.

SEC. 4103. MEDICARE COVERAGE OF ANNUAL WELLNESS VISIT PROVIDING A 
            PERSONALIZED PREVENTION PLAN.

    (a) Coverage of Personalized Prevention Plan Services.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (DD), by striking ``and'' at the 
                end;
                    (B) in subparagraph (EE), by adding ``and'' at the 
                end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(FF) personalized prevention plan services (as defined in 
        subsection (hhh));''.
            (2) Conforming amendments.--Clauses (i) and (ii) of section 
        1861(s)(2)(K) of the Social Security Act (42 U.S.C. 
        1395x(s)(2)(K)) are each amended by striking ``subsection 
        (ww)(1)'' and inserting ``subsections (ww)(1) and (hhh)''.

    (b) Personalized Prevention Plan Services Defined.--Section 1861 of 
the Social Security Act (42 U.S.C. 1395x) is amended by adding at the 
end the following new subsection:

                         ``Annual Wellness Visit

    ``(hhh)(1) The term `personalized prevention plan services' means 
the creation of a plan for an individual--
            ``(A) that includes a health risk assessment (that meets the 
        guidelines established by the Secretary under paragraph (4)(A)) 
        of the individual that is completed prior to or as part of the 
        same visit with a health professional described in paragraph 
        (3); and
            ``(B) that--
                    ``(i) takes into account the results of the health 
                risk assessment; and
                    ``(ii) may contain the elements described in 
                paragraph (2).

    ``(2) Subject to paragraph (4)(H), the elements described in this 
paragraph are the following:
            ``(A) The establishment of, or an update to, the 
        individual's medical and family history.
            ``(B) A list of current providers and suppliers that are 
        regularly involved in providing medical care to the individual 
        (including a list of all prescribed medications).

[[Page 124 STAT. 554]]

            ``(C) A measurement of height, weight, body mass index (or 
        waist circumference, if appropriate), blood pressure, and other 
        routine measurements.
            ``(D) Detection of any cognitive impairment.
            ``(E) The establishment of, or an update to, the following:
                    ``(i) A screening schedule for the next 5 to 10 
                years, as appropriate, based on recommendations of the 
                United States Preventive Services Task Force and the 
                Advisory Committee on Immunization Practices, and the 
                individual's health status, screening history, and age-
                appropriate preventive services covered under this 
                title.
                    ``(ii) A list of risk factors and conditions for 
                which primary, secondary, or tertiary prevention 
                interventions are recommended or are underway, including 
                any mental health conditions or any such risk factors or 
                conditions that have been identified through an initial 
                preventive physical examination (as described under 
                subsection (ww)(1)), and a list of treatment options and 
                their associated risks and benefits.
            ``(F) The furnishing of personalized health advice and a 
        referral, as appropriate, to health education or preventive 
        counseling services or programs aimed at reducing identified 
        risk factors and improving self-management, or community-based 
        lifestyle interventions to reduce health risks and promote self-
        management and wellness, including weight loss, physical 
        activity, smoking cessation, fall prevention, and nutrition.
            ``(G) Any other element determined appropriate by the 
        Secretary.

    ``(3) A health professional described in this paragraph is--
            ``(A) a physician;
            ``(B) a practitioner described in clause (i) of section 
        1842(b)(18)(C); or
            ``(C) a medical professional (including a health educator, 
        registered dietitian, or nutrition professional) or a team of 
        medical professionals, as determined appropriate by the 
        Secretary, under the supervision of a physician.

    ``(4)(A) For <<NOTE: Deadline. Public 
information. Guidelines.>> purposes of paragraph (1)(A), the Secretary, 
not later than 1 year after the date of enactment of this subsection, 
shall establish publicly available guidelines for health risk 
assessments. Such guidelines shall be developed in consultation with 
relevant groups and entities and shall provide that a health risk 
assessment--
            ``(i) identify chronic diseases, injury risks, modifiable 
        risk factors, and urgent health needs of the individual; and
            ``(ii) may be furnished--
                    ``(I) through an interactive telephonic or web-based 
                program that meets the standards established under 
                subparagraph (B);
                    ``(II) during an encounter with a health care 
                professional;
                    ``(III) through community-based prevention programs; 
                or
                    ``(IV) through any other means the Secretary 
                determines appropriate to maximize accessibility and 
                ease of use by beneficiaries, while ensuring the privacy 
                of such beneficiaries.

[[Page 124 STAT. 555]]

    ``(B) Not <<NOTE: Deadline. Standards. Communications and tele- 
communications. Web site.>> later than 1 year after the date of 
enactment of this subsection, the Secretary shall establish standards 
for interactive telephonic or web-based programs used to furnish health 
risk assessments under subparagraph (A)(ii)(I). The Secretary may 
utilize any health risk assessment developed under section 4004(f) of 
the Patient Protection and Affordable Care Act as part of the 
requirement to develop a personalized prevention plan to comply with 
this subparagraph.

    ``(C)(i) Not later <<NOTE: Deadline. Public information. Assessment 
model.>> than 18 months after the date of enactment of this subsection, 
the Secretary shall develop and make available to the public a health 
risk assessment model. Such model shall meet the guidelines under 
subparagraph (A) and may be used to meet the requirement under paragraph 
(1)(A).

    ``(ii) Any health risk assessment that meets the guidelines under 
subparagraph (A) and is approved by the Secretary may be used to meet 
the requirement under paragraph (1)(A).
    ``(D) The Secretary may coordinate with community-based entities 
(including State Health Insurance Programs, Area Agencies on Aging, 
Aging and Disability Resource Centers, and the Administration on Aging) 
to--
            ``(i) ensure that health risk assessments are accessible to 
        beneficiaries; and
            ``(ii) provide appropriate support for the completion of 
        health risk assessments by beneficiaries.

    ``(E) The <<NOTE: Procedures.>> Secretary shall establish procedures 
to make beneficiaries and providers aware of the requirement that a 
beneficiary complete a health risk assessment prior to or at the same 
time as receiving personalized prevention plan services.

    ``(F) To the extent practicable, the Secretary shall encourage the 
use of, integration with, and coordination of health information 
technology (including use of technology that is compatible with 
electronic medical records and personal health records) and may 
experiment with the use of personalized technology to aid in the 
development of self-management skills and management of and adherence to 
provider recommendations in order to improve the health status of 
beneficiaries.
    ``(G)(i) A beneficiary shall only be eligible to receive an initial 
preventive physical examination (as defined under subsection (ww)(1)) at 
any time during the 12-month period after the date that the 
beneficiary's coverage begins under part B and shall be eligible to 
receive personalized prevention plan services under this subsection 
provided that the beneficiary has not received such services within the 
preceding 12-month period.
    ``(ii) The Secretary <<NOTE: Procedures.>> shall establish 
procedures to make beneficiaries aware of the option to select an 
initial preventive physical examination or personalized prevention plan 
services during the period of 12 months after the date that a 
beneficiary's coverage begins under part B, which shall include 
information regarding any relevant differences between such services.

    ``(H) The <<NOTE: Guidance.>> Secretary shall issue guidance that--
            ``(i) identifies elements under paragraph (2) that are 
        required to be provided to a beneficiary as part of their first 
        visit for personalized prevention plan services; and
            ``(ii) establishes a yearly schedule for appropriate 
        provision of such elements thereafter.''.

    (c) Payment and Elimination of Cost-Sharing.--

[[Page 124 STAT. 556]]

            (1) Payment and elimination of coinsurance.--Section 
        1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is 
        amended--
                    (A) in subparagraph (N), by inserting ``other than 
                personalized prevention plan services (as defined in 
                section 1861(hhh)(1))'' after ``(as defined in section 
                1848(j)(3))'';
                    (B) by striking ``and'' before ``(W)''; and
                    (C) by inserting before the semicolon at the end the 
                following: ``, and (X) with respect to personalized 
                prevention plan services (as defined in section 
                1861(hhh)(1)), the amount paid shall be 100 percent of 
                the lesser of the actual charge for the services or the 
                amount determined under the payment basis determined 
                under section 1848''.
            (2) Payment under physician fee schedule.--Section 
        1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) 
        is amended by inserting ``(2)(FF) (including administration of 
        the health risk assessment) ,'' after ``(2)(EE),''.
            (3) Elimination of coinsurance in outpatient hospital 
        settings.--
                    (A) Exclusion from opd fee schedule.--Section 
                1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 
                1395l(t)(1)(B)(iv)) is amended by striking ``and 
                diagnostic mammography'' and inserting ``, diagnostic 
                mammography, or personalized prevention plan services 
                (as defined in section 1861(hhh)(1))''.
                    (B) Conforming amendments.--Section 1833(a)(2) of 
                the Social Security Act (42 U.S.C. 1395l(a)(2)) is 
                amended--
                          (i) in subparagraph (F), by striking ``and'' 
                      at the end;
                          (ii) in subparagraph (G)(ii), by striking the 
                      comma at the end and inserting ``; and''; and
                          (iii) by inserting after subparagraph (G)(ii) 
                      the following new subparagraph:
                    ``(H) with respect to personalized prevention plan 
                services (as defined in section 1861(hhh)(1)) furnished 
                by an outpatient department of a hospital, the amount 
                determined under paragraph (1)(X),''.
            (4) Waiver of application of deductible.--The first sentence 
        of section 1833(b) of the Social Security Act (42 U.S.C. 
        1395l(b)) is amended--
                    (A) by striking ``and'' before ``(9)''; and
                    (B) by inserting before the period the following: 
                ``, and (10) such deductible shall not apply with 
                respect to personalized prevention plan services (as 
                defined in section 1861(hhh)(1))''.

    (d) Frequency Limitation.--Section 1862(a) of the Social Security 
Act (42 U.S.C. 1395y(a)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (N), by striking ``and'' at the 
                end;
                    (B) in subparagraph (O), by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(P) in the case of personalized prevention plan services 
        (as defined in section 1861(hhh)(1)), which are performed more 
        frequently than is covered under such section;''; and

[[Page 124 STAT. 557]]

            (2) in paragraph (7), by striking ``or (K)'' and inserting 
        ``(K), or (P)''.

    (e) Effective <<NOTE: 42 USC 1395l note.>> Date.--The amendments 
made by this section shall apply to services furnished on or after 
January 1, 2011.

SEC. 4104. REMOVAL OF BARRIERS TO PREVENTIVE SERVICES IN MEDICARE.

    (a) Definition of Preventive Services.--Section 1861(ddd) of the 
Social Security Act (42 U.S.C. 1395x(ddd)) is amended--
            (1) in the heading, by inserting ``; Preventive Services'' 
        after ``Services'';
            (2) in paragraph (1), by striking ``not otherwise described 
        in this title'' and inserting ``not described in subparagraph 
        (A) or (C) of paragraph (3)''; and
            (3) by adding at the end the following new paragraph:

    ``(3) The term `preventive services' means the following:
            ``(A) The screening and preventive services described in 
        subsection (ww)(2) (other than the service described in 
        subparagraph (M) of such subsection).
            ``(B) An initial preventive physical examination (as defined 
        in subsection (ww)).
            ``(C) Personalized prevention plan services (as defined in 
        subsection (hhh)(1)).''.

    (b) Coinsurance.--
            (1) General application.--
                    (A) In general.--Section 1833(a)(1) of the Social 
                Security Act (42 U.S.C. 1395l(a)(1)), as amended by 
                section 4103(c)(1), is amended--
                          (i) in subparagraph (T), by inserting ``(or 
                      100 percent if such services are recommended with 
                      a grade of A or B by the United States Preventive 
                      Services Task Force for any indication or 
                      population and are appropriate for the 
                      individual)'' after ``80 percent'';
                          (ii) in subparagraph (W)--
                                    (I) in clause (i), by inserting 
                                ``(if such subparagraph were applied, by 
                                substituting `100 percent' for `80 
                                percent')'' after ``subparagraph (D)''; 
                                and
                                    (II) in clause (ii), by striking 
                                ``80 percent'' and inserting ``100 
                                percent'';
                          (iii) by striking ``and'' before ``(X)''; and
                          (iv) by inserting before the semicolon at the 
                      end the following: ``, and (Y) with respect to 
                      preventive services described in subparagraphs (A) 
                      and (B) of section 1861(ddd)(3) that are 
                      appropriate for the individual and, in the case of 
                      such services described in subparagraph (A), are 
                      recommended with a grade of A or B by the United 
                      States Preventive Services Task Force for any 
                      indication or population, the amount paid shall be 
                      100 percent of the lesser of the actual charge for 
                      the services or the amount determined under the 
                      fee schedule that applies to such services under 
                      this part''.
            (2) Elimination of coinsurance in outpatient hospital 
        settings.--
                    (A) Exclusion from opd fee schedule.--Section 
                1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C.

[[Page 124 STAT. 558]]

                1395l(t)(1)(B)(iv)), as amended by section 
                4103(c)(3)(A), is amended--
                          (i) by striking ``or'' before ``personalized 
                      prevention plan services''; and
                          (ii) by inserting before the period the 
                      following: ``, or preventive services described in 
                      subparagraphs (A) and (B) of section 1861(ddd)(3) 
                      that are appropriate for the individual and, in 
                      the case of such services described in 
                      subparagraph (A), are recommended with a grade of 
                      A or B by the United States Preventive Services 
                      Task Force for any indication or population''.
                    (B) Conforming amendments.--Section 1833(a)(2) of 
                the Social Security Act (42 U.S.C. 1395l(a)(2)), as 
                amended by section 4103(c)(3)(B), is amended--
                          (i) in subparagraph (G)(ii), by striking 
                      ``and'' after the semicolon at the end;
                          (ii) in subparagraph (H), by striking the 
                      comma at the end and inserting ``; and''; and
                          (iii) by inserting after subparagraph (H) the 
                      following new subparagraph:
                    ``(I) with respect to preventive services described 
                in subparagraphs (A) and (B) of section 1861(ddd)(3) 
                that are appropriate for the individual and are 
                furnished by an outpatient department of a hospital and, 
                in the case of such services described in subparagraph 
                (A), are recommended with a grade of A or B by the 
                United States Preventive Services Task Force for any 
                indication or population, the amount determined under 
                paragraph (1)(W) or (1)(Y),''.

    (c) Waiver of Application of Deductible for Preventive Services and 
Colorectal Cancer Screening Tests.--Section 1833(b) of the Social 
Security Act (42 U.S.C. 1395l(b)), as amended by section 4103(c)(4), is 
amended--
            (1) in paragraph (1), by striking ``items and services 
        described in section 1861(s)(10)(A)'' and inserting ``preventive 
        services described in subparagraph (A) of section 1861(ddd)(3) 
        that are recommended with a grade of A or B by the United States 
        Preventive Services Task Force for any indication or population 
        and are appropriate for the individual.''; and
            (2) by adding at the end the following new sentence: 
        ``Paragraph (1) of the first sentence of this subsection shall 
        apply with respect to a colorectal cancer screening test 
        regardless of the code that is billed for the establishment of a 
        diagnosis as a result of the test, or for the removal of tissue 
        or other matter or other procedure that is furnished in 
        connection with, as a result of, and in the same clinical 
        encounter as the screening test.''.

    (d) Effective <<NOTE: 42 USC 1395l note.>> Date.--The amendments 
made by this section shall apply to items and services furnished on or 
after January 1, 2011.

SEC. 4105. EVIDENCE-BASED COVERAGE OF PREVENTIVE SERVICES IN MEDICARE.

    (a) Authority To Modify or Eliminate Coverage of Certain Preventive 
Services.--Section 1834 of the Social Security Act (42 U.S.C. 1395m) is 
amended by adding at the end the following new subsection:

[[Page 124 STAT. 559]]

    ``(n) Authority To Modify or Eliminate Coverage of Certain 
Preventive Services.--Notwithstanding <<NOTE: Effective date.>> any 
other provision of this title, effective beginning on January 1, 2010, 
if the Secretary determines appropriate, the Secretary may--
            ``(1) modify--
                    ``(A) the coverage of any preventive service 
                described in subparagraph (A) of section 1861(ddd)(3) to 
                the extent that such modification is consistent with the 
                recommendations of the United States Preventive Services 
                Task Force; and
                    ``(B) the services included in the initial 
                preventive physical examination described in 
                subparagraph (B) of such section; and
            ``(2) provide that no payment shall be made under this title 
        for a preventive service described in subparagraph (A) of such 
        section that has not received a grade of A, B, C, or I by such 
        Task Force.''.

    (b) Construction.--Nothing <<NOTE: 42 USC 1395m note.>> in the 
amendment made by paragraph (1) shall be construed to affect the 
coverage of diagnostic or treatment services under title XVIII of the 
Social Security Act.

SEC. 4106. IMPROVING ACCESS TO PREVENTIVE SERVICES FOR ELIGIBLE ADULTS 
            IN MEDICAID.

    (a) Clarification of Inclusion of Services.--Section 1905(a)(13) of 
the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended to read as 
follows:
            ``(13) other diagnostic, screening, preventive, and 
        rehabilitative services, including--
                    ``(A) any clinical preventive services that are 
                assigned a grade of A or B by the United States 
                Preventive Services Task Force;
                    ``(B) with respect to an adult individual, approved 
                vaccines recommended by the Advisory Committee on 
                Immunization Practices (an advisory committee 
                established by the Secretary, acting through the 
                Director of the Centers for Disease Control and 
                Prevention) and their administration; and
                    ``(C) any medical or remedial services (provided in 
                a facility, a home, or other setting) recommended by a 
                physician or other licensed practitioner of the healing 
                arts within the scope of their practice under State law, 
                for the maximum reduction of physical or mental 
                disability and restoration of an individual to the best 
                possible functional level;''.

    (b) Increased Fmap.--Section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)), as amended by sections 2001(a)(3)(A) and 2004(c)(1), 
is amended in the first sentence--
            (1) by striking ``, and (4)'' and inserting ``, (4)''; and
            (2) by inserting before the period the following: ``, and 
        (5) in the case of a State that provides medical assistance for 
        services and vaccines described in subparagraphs (A) and (B) of 
        subsection (a)(13), and prohibits cost-sharing for such services 
        and vaccines, the Federal medical assistance percentage, as 
        determined under this subsection and subsection (y) (without 
        regard to paragraph (1)(C) of such subsection), shall be 
        increased by 1 percentage point with respect to medical

[[Page 124 STAT. 560]]

        assistance for such services and vaccines and for items and 
        services described in subsection (a)(4)(D)''.

    (c) Effective <<NOTE: 42 USC 1396d note.>> Date.--The amendments 
made under this section shall take effect on January 1, 2013.

SEC. 4107. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES FOR 
            PREGNANT WOMEN IN MEDICAID.

    (a) Requiring Coverage of Counseling and Pharmacotherapy for 
Cessation of Tobacco Use by Pregnant Women.--Section 1905 of the Social 
Security Act (42 U.S.C. 1396d), as amended by sections 2001(a)(3)(B) and 
2303, is further amended--
            (1) in subsection (a)(4)--
                    (A) by striking ``and'' before ``(C)''; and
                    (B) by inserting before the semicolon at the end the 
                following new subparagraph: ``; and (D) counseling and 
                pharmacotherapy for cessation of tobacco use by pregnant 
                women (as defined in subsection (bb))''; and
            (2) by adding at the end the following:

    ``(bb)(1) For <<NOTE: Definition.>> purposes of this title, the term 
`counseling and pharmacotherapy for cessation of tobacco use by pregnant 
women' means diagnostic, therapy, and counseling services and 
pharmacotherapy (including the coverage of prescription and 
nonprescription tobacco cessation agents approved by the Food and Drug 
Administration) for cessation of tobacco use by pregnant women who use 
tobacco products or who are being treated for tobacco use that is 
furnished--
            ``(A) by or under the supervision of a physician; or
            ``(B) by any other health care professional who--
                    ``(i) is legally authorized to furnish such services 
                under State law (or the State regulatory mechanism 
                provided by State law) of the State in which the 
                services are furnished; and
                    ``(ii) is authorized to receive payment for other 
                services under this title or is designated by the 
                Secretary for this purpose.

    ``(2) Subject to paragraph (3), such term is limited to--
            ``(A) services recommended with respect to pregnant women in 
        `Treating Tobacco Use and Dependence: 2008 Update: A Clinical 
        Practice Guideline', published by the Public Health Service in 
        May 2008, or any subsequent modification of such Guideline; and
            ``(B) such other services that the Secretary recognizes to 
        be effective for cessation of tobacco use by pregnant women.

    ``(3) Such term shall not include coverage for drugs or biologicals 
that are not otherwise covered under this title.''.
    (b) Exception From Optional Restriction Under Medicaid Prescription 
Drug Coverage.--Section 1927(d)(2)(F) of the Social Security Act (42 
U.S.C. 1396r-8(d)(2)(F)), as redesignated by section 2502(a), is amended 
by inserting before the period at the end the following: ``, except, in 
the case of pregnant women when recommended in accordance with the 
Guideline referred to in section 1905(bb)(2)(A), agents approved by the 
Food and Drug Administration under the over-the-counter monograph 
process for purposes of promoting, and when used to promote, tobacco 
cessation''.

[[Page 124 STAT. 561]]

    (c) Removal of Cost-Sharing for Counseling and Pharmacotherapy for 
Cessation of Tobacco Use by Pregnant Women.--
            (1) General cost-sharing limitations.--Section 1916 of the 
        Social Security Act (42 U.S.C. 1396o) is amended in each of 
        subsections (a)(2)(B) and (b)(2)(B) by inserting ``, and 
        counseling and pharmacotherapy for cessation of tobacco use by 
        pregnant women (as defined in section 1905(bb)) and covered 
        outpatient drugs (as defined in subsection (k)(2) of section 
        1927 and including nonprescription drugs described in subsection 
        (d)(2) of such section) that are prescribed for purposes of 
        promoting, and when used to promote, tobacco cessation by 
        pregnant women in accordance with the Guideline referred to in 
        section 1905(bb)(2)(A)'' after ``complicate the pregnancy''.
            (2) Application to alternative cost-sharing.--Section 
        1916A(b)(3)(B)(iii) of such Act (42 U.S.C. 1396o-
        1(b)(3)(B)(iii)) is amended by inserting ``, and counseling and 
        pharmacotherapy for cessation of tobacco use by pregnant women 
        (as defined in section 1905(bb))'' after ``complicate the 
        pregnancy''.

    (d) Effective <<NOTE: 42 USC 1396d note.>> Date.--The amendments 
made by this section shall take effect on October 1, 2010.

SEC. 4108. INCENTIVES <<NOTE: Grants. 42 USC 1396a note.>> FOR 
            PREVENTION OF CHRONIC DISEASES IN MEDICAID.

    (a) Initiatives.--
            (1) Establishment.--
                    (A) In general.--The Secretary shall award grants to 
                States to carry out initiatives to provide incentives to 
                Medicaid beneficiaries who--
                          (i) successfully participate in a program 
                      described in paragraph (3); and
                          (ii) upon completion of such participation, 
                      demonstrate changes in health risk and outcomes, 
                      including the adoption and maintenance of healthy 
                      behaviors by meeting specific targets (as 
                      described in subsection (c)(2)).
                    (B) Purpose.--The purpose of the initiatives under 
                this section is to test approaches that may encourage 
                behavior modification and determine scalable solutions.
            (2) Duration.--
                    (A) Initiation <<NOTE: Effective date.>> of program; 
                resources.--The Secretary shall awards grants to States 
                beginning on January 1, 2011, or beginning on the date 
                on which the Secretary develops program criteria, 
                whichever is <<NOTE: Criteria.>> earlier. The Secretary 
                shall develop program criteria for initiatives under 
                this section using relevant evidence-based research and 
                resources, including the Guide to Community Preventive 
                Services, the Guide to Clinical Preventive Services, and 
                the National Registry of Evidence-Based Programs and 
                Practices.
                    (B) Duration <<NOTE: Deadline.>> of program.--A 
                State awarded a grant to carry out initiatives under 
                this section shall carry out such initiatives within the 
                5-year period beginning on January 1, 2011, or beginning 
                on the date on which the Secretary develops program 
                criteria, whichever is earlier. Initiatives under this 
                section shall be carried out by a State for a period of 
                not less than 3 years.

[[Page 124 STAT. 562]]

            (3) Program described.--
                    (A) In general.--A program described in this 
                paragraph is a comprehensive, evidence-based, widely 
                available, and easily accessible program, proposed by 
                the State and approved by the Secretary, that is 
                designed and uniquely suited to address the needs of 
                Medicaid beneficiaries and has demonstrated success in 
                helping individuals achieve one or more of the 
                following:
                          (i) Ceasing use of tobacco products.
                          (ii) Controlling or reducing their weight.
                          (iii) Lowering their cholesterol.
                          (iv) Lowering their blood pressure.
                          (v) Avoiding the onset of diabetes or, in the 
                      case of a diabetic, improving the management of 
                      that condition.
                    (B) Co-morbidities.--A program under this section 
                may also address co-morbidities (including depression) 
                that are related to any of the conditions described in 
                subparagraph (A).
                    (C) Waiver authority.--The Secretary may waive the 
                requirements of section 1902(a)(1) (relating to 
                statewideness) of the Social Security Act for a State 
                awarded a grant to conduct an initiative under this 
                section and shall ensure that a State makes any program 
                described in subparagraph (A) available and accessible 
                to Medicaid beneficiaries.
                    (D) Flexibility in implementation.--A State may 
                enter into arrangements with providers participating in 
                Medicaid, community-based organizations, faith-based 
                organizations, public-private partnerships, Indian 
                tribes, or similar entities or organizations to carry 
                out programs described in subparagraph (A).
            (4) Application.--Following the development of program 
        criteria by the Secretary, a State may submit an application, in 
        such manner and containing such information as the Secretary may 
        require, that shall include a proposal for programs described in 
        paragraph (3)(A) and a plan to make Medicaid beneficiaries and 
        providers participating in Medicaid who reside in the State 
        aware and informed about such programs.

    (b) Education and Outreach Campaign.--
            (1) State awareness.--The Secretary shall conduct an 
        outreach and education campaign to make States aware of the 
        grants under this section.
            (2) Provider and beneficiary education.--A State awarded a 
        grant to conduct an initiative under this section shall conduct 
        an outreach and education campaign to make Medicaid 
        beneficiaries and providers participating in Medicaid who reside 
        in the State aware of the programs described in subsection 
        (a)(3) that are to be carried out by the State under the grant.

    (c) Impact.--A State awarded a grant to conduct an initiative under 
this section shall develop and implement a system to--
            (1) track Medicaid beneficiary participation in the program 
        and validate changes in health risk and outcomes with clinical 
        data, including the adoption and maintenance of health behaviors 
        by such beneficiaries;

[[Page 124 STAT. 563]]

            (2) to the extent practicable, establish standards and 
        health status targets for Medicaid beneficiaries participating 
        in the program and measure the degree to which such standards 
        and targets are met;
            (3) evaluate the effectiveness of the program and provide 
        the Secretary with such evaluations;
            (4) report <<NOTE: Reports.>> to the Secretary on processes 
        that have been developed and lessons learned from the program; 
        and
            (5) report <<NOTE: Reports.>> on preventive services as part 
        of reporting on quality measures for Medicaid managed care 
        programs.

    (d) Evaluations and Reports.--
            (1) Independent <<NOTE: Contracts.>> assessment.--The 
        Secretary shall enter into a contract with an independent entity 
        or organization to conduct an evaluation and assessment of the 
        initiatives carried out by States under this section, for the 
        purpose of determining--
                    (A) the effect of such initiatives on the use of 
                health care services by Medicaid beneficiaries 
                participating in the program;
                    (B) the extent to which special populations 
                (including adults with disabilities, adults with chronic 
                illnesses, and children with special health care needs) 
                are able to participate in the program;
                    (C) the level of satisfaction of Medicaid 
                beneficiaries with respect to the accessibility and 
                quality of health care services provided through the 
                program; and
                    (D) the administrative costs incurred by State 
                agencies that are responsible for administration of the 
                program.
            (2) State reporting.--A State awarded a grant to carry out 
        initiatives under this section shall submit reports to the 
        Secretary, on a semi-annual basis, regarding the programs that 
        are supported by the grant funds. Such report shall include 
        information, as specified by the Secretary, regarding--
                    (A) the specific uses of the grant funds;
                    (B) an assessment of program implementation and 
                lessons learned from the programs;
                    (C) an assessment of quality improvements and 
                clinical outcomes under such programs; and
                    (D) estimates of cost savings resulting from such 
                programs.
            (3) Initial report.--Not later than January 1, 2014, the 
        Secretary shall submit to Congress an initial report on such 
        initiatives based on information provided by States through 
        reports required under paragraph (2). The initial report shall 
        include an interim evaluation of the effectiveness of the 
        initiatives carried out with grants awarded under this section 
        and a recommendation regarding whether funding for expanding or 
        extending the initiatives should be extended beyond January 1, 
        2016.
            (4) Final report.--Not later than July 1, 2016, the 
        Secretary shall submit to Congress a final report on the program 
        that includes the results of the independent assessment required 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Secretary 
        determines appropriate.

[[Page 124 STAT. 564]]

    (e) No Effect on Eligibility for, or Amount of, Medicaid or Other 
Benefits.--Any incentives provided to a Medicaid beneficiary 
participating in a program described in subsection (a)(3) shall not be 
taken into account for purposes of determining the beneficiary's 
eligibility for, or amount of, benefits under the Medicaid program or 
any program funded in whole or in part with Federal funds.
    (f) Funding.--Out of any funds in the Treasury not otherwise 
appropriated, there are appropriated for the 5-year period beginning on 
January 1, 2011, $100,000,000 to the Secretary to carry out this 
section. Amounts appropriated under this subsection shall remain 
available until expended.
    (g) Definitions.--In this section:
            (1) Medicaid beneficiary.--The term ``Medicaid beneficiary'' 
        means an individual who is eligible for medical assistance under 
        a State plan or waiver under title XIX of the Social Security 
        Act (42 U.S.C. 1396 et seq.) and is enrolled in such plan or 
        waiver.
            (2) State.--The term ``State'' has the meaning given that 
        term for purposes of title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).

               Subtitle C--Creating Healthier Communities

SEC. 4201. COMMUNITY <<NOTE: 42 USC 300u-13.>> 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.--

[[Page 124 STAT. 565]]

            (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;

[[Page 124 STAT. 566]]

                          (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.
                    (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. 4202. HEALTHY <<NOTE: 42 USC 300u-14.>> AGING, LIVING WELL; 
            EVALUATION OF COMMUNITY-BASED PREVENTION AND WELLNESS 
            PROGRAMS FOR MEDICARE BENEFICIARIES.

    (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;

[[Page 124 STAT. 567]]

                          (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 <<NOTE: Records.>> under this section 
                      shall maintain records of screening results under 
                      this subparagraph to establish the baseline data 
                      for monitoring the targeted population

[[Page 124 STAT. 568]]

                    (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) Mechanism.--
                                    (I) Identification and determination 
                                of status.--With respect to each 
                                individual with risk factors for or 
                                having heart disease, stroke, diabetes, 
                                or any other condition for which such 
                                individual was screened under 
                                subparagraph (C), a grantee under this 
                                section shall determine whether or not 
                                such individual is covered under any 
                                public or private health insurance 
                                program.
                                    (II) Insured individuals.--An 
                                individual determined to be covered 
                                under a health insurance program under 
                                subclause (I) shall be referred by the 
                                grantee to the existing providers under 
                                such program or, if such individual does 
                                not have a current provider, to a 
                                provider who is in-network with respect 
                                to the program involved.
                                    (III) Uninsured individuals.--With 
                                respect to an individual determined to 
                                be uninsured under subclause (I), the 
                                grantee's community-based clinical 
                                partner described in paragraph (4)(D) 
                                shall assist the individual in 
                                determining eligibility for available 
                                public coverage options and identify 
                                other appropriate community health care 
                                resources and assistance programs.
                          (iii) 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 new Medicare 
        enrollees (or individuals nearing enrollment, including those 
        who are 63 and 64 years of age) who reside in States or 
        localities receiving grants under this section as compared with 
        national and historical data for those States and localities for 
        the same population.

[[Page 124 STAT. 569]]

            (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 for Medicare Beneficiaries.--
            (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 Medicare beneficiaries.
            (2) Medicare 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 Medicare beneficiaries (particularly beneficiaries 
                that have attained 65 years of age) reduce 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 the Medicare population. 
                      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 
                      Administrator of the Centers for Medicare & 
                      Medicaid Services, in consultation with 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 Medicare beneficiaries who participate in 
                      such programs--
                                    (I) reduce their health risks, 
                                improve their health outcomes, and adopt 
                                and maintain healthy behaviors;
                                    (II) improve their ability to manage 
                                their chronic conditions; and
                                    (III) reduce their utilization of 
                                health services and associated costs 
                                under the Medicare program for 
                                conditions that are amenable to 
                                improvement under such programs.
            (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

[[Page 124 STAT. 570]]

                promote healthy lifestyles and chronic disease self-
                management for Medicare beneficiaries;
                    (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.
            (6) Medicare <<NOTE: Definition.>> beneficiary.--In this 
        subsection, the term ``Medicare beneficiary'' means an 
        individual who is entitled to benefits under part A of title 
        XVIII of the Social Security Act and enrolled under part B of 
        such title.

SEC. 4203. 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 <<NOTE: 29 USC 794f.>> OF STANDARDS FOR 
            ACCESSIBLE MEDICAL DIAGNOSTIC EQUIPMENT.

    ``(a) Standards.--Not <<NOTE: Deadline.>> later than 24 months after 
the date of enactment of the Affordable Health Choices Act, the 
Architectural and Transportation Barriers Compliance Board shall, in 
consultation with the Commissioner of the Food and Drug Administration, 
promulgate regulatory standards in accordance with the Administrative 
Procedure Act (2 U.S.C. 551 et seq.) setting forth the minimum technical 
criteria for medical diagnostic equipment used in (or in conjunction 
with) physician's offices, clinics, emergency rooms, hospitals, and 
other medical settings. The standards shall ensure that such equipment 
is accessible to, and usable by, individuals with accessibility needs, 
and shall allow independent entry to, use of, and exit from the 
equipment by such individuals to the maximum extent possible.

    ``(b) Medical Diagnostic Equipment Covered.--The standards issued 
under subsection (a) for medical diagnostic equipment shall apply to 
equipment that includes examination tables, examination chairs 
(including chairs used for eye examinations or procedures, and dental 
examinations or procedures), weight scales, mammography equipment, x-ray 
machines, and other radiological equipment commonly used for diagnostic 
purposes by health professionals.
    ``(c) Review and Amendment.--The Architectural and Transportation 
Barriers Compliance Board, in consultation with the Commissioner of the 
Food and Drug Administration, shall periodically review and, as 
appropriate, amend the standards in accordance with the Administrative 
Procedure Act (2 U.S.C. 551 et seq.).''.

[[Page 124 STAT. 571]]

SEC. 4204. 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 <<NOTE: Grants.>> 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;

[[Page 124 STAT. 572]]

                    ``(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 <<NOTE: Deadline.>> later than 3 
        years after the date on which a State receives a grant under 
        this subsection, the State shall submit to the Secretary an 
        evaluation of progress made toward improving immunization 
        coverage rates among high-risk populations within the State.
            ``(6) Report to congress.--Not later than 4 years after the 
        date of enactment of the Affordable Health Choices Act, the 
        Secretary shall submit to Congress a report concerning the 
        effectiveness of the demonstration program established under 
        this subsection together with recommendations on whether to 
        continue and expand such program.
            ``(7) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, such sums as 
        may be necessary for each of fiscal years 2010 through 2014.''.

    (c) Reauthorization of Immunization Program.--Section 317(j) of the 
Public Health Service Act (42 U.S.C. 247b(j)) is amended--
            (1) in paragraph (1), by striking ``for each of the fiscal 
        years 1998 through 2005''; and
            (2) in paragraph (2), by striking ``after October 1, 
        1997,''.

    (d) Rule of <<NOTE: 42 USC 247b note.>> 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.

    (e) GAO Study and Report on Medicare Beneficiary Access to 
Vaccines.--
            (1) Study.--The Comptroller General of the United States (in 
        this section referred to as the ``Comptroller General'') shall 
        conduct a study on the ability of Medicare beneficiaries who 
        were 65 years of age or older to access routinely recommended 
        vaccines covered under the prescription drug program under part 
        D of title XVIII of the Social Security Act over the period 
        since the establishment of such program. Such study shall 
        include the following:
                    (A) An analysis and determination of--
                          (i) the number of Medicare beneficiaries who 
                      were 65 years of age or older and were eligible 
                      for a routinely recommended vaccination that was 
                      covered under part D;

[[Page 124 STAT. 573]]

                          (ii) the number of such beneficiaries who 
                      actually received a routinely recommended 
                      vaccination that was covered under part D; and
                          (iii) any barriers to access by such 
                      beneficiaries to routinely recommended 
                      vaccinations that were covered under part D.
                    (B) A summary of the findings and recommendations by 
                government agencies, departments, and advisory bodies 
                (as well as relevant professional organizations) on the 
                impact of coverage under part D of routinely recommended 
                adult immunizations for access to such immunizations by 
                Medicare beneficiaries.
            (2) Report.--Not later than June 1, 2011, the Comptroller 
        General shall submit to the appropriate committees of 
        jurisdiction of the House of Representatives and the Senate a 
        report containing the results of the study conducted under 
        paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller General 
        determines appropriate.
            (3) Funding.--Out of any funds in the Treasury not otherwise 
        appropriated, there are appropriated $1,000,000 for fiscal year 
        2010 to carry out this subsection.

SEC. 4205. 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

[[Page 124 STAT. 574]]

                contained in the standard menu item, as usually prepared 
                and offered for sale; and
                    ``(bb) a succinct statement concerning suggested 
                daily caloric intake, as specified by the Secretary by 
                regulation and posted prominently on the menu and 
                designed to enable the public to understand, in the 
                context of a total daily diet, the significance of the 
                caloric information that is provided on the menu;
                    ``(II)(aa) in a nutrient content disclosure 
                statement adjacent to the name of the standard menu 
                item, so as to be clearly associated with the standard 
                menu item, on the menu board, including a drive-through 
                menu board, the number of calories contained in the 
                standard menu item, as usually prepared and offered for 
                sale; and
                    ``(bb) a succinct statement concerning suggested 
                daily caloric intake, as specified by the Secretary by 
                regulation and posted prominently on the menu board, 
                designed to enable the public to understand, in the 
                context of a total daily diet, the significance of the 
                nutrition information that is provided on the menu 
                board;
            ``(III) in a written form, available on the premises of the 
        restaurant or similar retail establishment and to the consumer 
        upon request, the nutrition information required under clauses 
        (C) and (D) of subparagraph (1); and
            ``(IV) on the menu or menu board, a prominent, clear, and 
        conspicuous statement regarding the availability of the 
        information described in item (III).
            ``(iii) Self-service food and food on display.--Except as 
        provided in subclause (vii), in the case of food sold at a salad 
        bar, buffet line, cafeteria line, or similar self-service 
        facility, and for self-service beverages or food that is on 
        display and that is visible to customers, a restaurant or 
        similar retail food establishment shall place adjacent to each 
        food offered a sign that lists calories per displayed food item 
        or per serving.
            ``(iv) Reasonable basis.--For the purposes of this clause, a 
        restaurant or similar retail food establishment shall have a 
        reasonable basis for its nutrient content disclosures, including 
        nutrient databases, cookbooks, laboratory analyses, and other 
        reasonable means, as described in section 101.10 of title 21, 
        Code of Federal Regulations (or any successor regulation) or in 
        a related guidance of the Food and Drug Administration.
            ``(v) Menu variability and combination meals.--The Secretary 
        shall establish by regulation standards for determining and 
        disclosing the nutrient content for standard menu items that 
        come in different flavors, varieties, or combinations, but which 
        are listed as a single menu item, such as soft drinks, ice 
        cream, pizza, doughnuts, or children's combination meals, 
        through means determined by the Secretary, including ranges, 
        averages, or other methods.
            ``(vi) Additional information.--If the Secretary determines 
        that a nutrient, other than a nutrient required under subclause 
        (ii)(III), should be disclosed for the purpose of providing 
        information to assist consumers in maintaining healthy dietary 
        practices, the Secretary may require, by regulation, disclosure 
        of such nutrient in the written form required under subclause 
        (ii)(III).
            ``(vii) Nonapplicability to certain food.--

[[Page 124 STAT. 575]]

                    ``(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 <<NOTE: Applicability.>> 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 <<NOTE: Deadline. Notice. Federal Register, 
                publication.>> 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 <<NOTE: Deadline.>> 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

[[Page 124 STAT. 576]]

                      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 <<NOTE: 21 USC 343 note.>> 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. 4206. 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 wellness plan that is designed to reduce risk

[[Page 124 STAT. 577]]

        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. 4207. 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.

[[Page 124 STAT. 578]]

    ``(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. 4301. RESEARCH <<NOTE: 42 USC 300u-15.>> ON OPTIMIZING THE DELIVERY 
            OF PUBLIC HEALTH SERVICES.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), acting through the 
Director of the Centers for Disease Control and Prevention, shall 
provide funding for research in the area of public health services and 
systems.
    (b) Requirements of Research.--Research supported under this section 
shall include--
            (1) examining evidence-based practices relating to 
        prevention, with a particular focus on high priority areas as 
        identified by the Secretary in the National Prevention Strategy 
        or Healthy People 2020, and including comparing community-based 
        public health interventions in terms of effectiveness and cost;
            (2) analyzing the translation of interventions from academic 
        settings to real world settings; and
            (3) identifying effective strategies for organizing, 
        financing, or delivering public health services in real world 
        community settings, including comparing State and local health 
        department structures and systems in terms of effectiveness and 
        cost.

    (c) Existing Partnerships.--Research supported under this section 
shall be coordinated with the Community Preventive Services Task Force 
and carried out by building on existing partnerships within the Federal 
Government while also considering initiatives at the State and local 
levels and in the private sector.
    (d) Annual Report.--The Secretary shall, on an annual basis, submit 
to Congress a report concerning the activities and findings with respect 
to research supported under this section.

SEC. 4302. 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. <<NOTE: 42 USC 300kk.>> DATA COLLECTION, ANALYSIS, AND 
            QUALITY.

    ``(a) Data Collection.--
            ``(1) In <<NOTE: Deadline.>> 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

[[Page 124 STAT. 579]]

        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 <<NOTE: Standards.>> national 
                standards for the management of data collected; and
                    ``(B) develop interoperability and security systems 
                for data management.

[[Page 124 STAT. 580]]

    ``(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 Centers for Medicare & Medicaid Services;
                    ``(F) the Indian Health Service and epidemiology 
                centers funded under the Indian Health Care Improvement 
                Act;
                    ``(G) the Office of Rural health;
                    ``(H) other agencies within the Department of Health 
                and Human Services; and
                    ``(I) 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 <<NOTE: Public information. Web 
                sites.>> 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

[[Page 124 STAT. 581]]

                    ``(B) all appropriate information security 
                safeguards are used in the collection, analysis, and 
                sharing of data collected pursuant to subsection (a).
            ``(2) Data <<NOTE: Procedures.>> 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.''.
    (b) Addressing Health Care Disparities in Medicaid and CHIP.--
            (1) Standardized collection requirements included in state 
        plans.--
                    (A) Medicaid.--Section 1902(a) of the Social 
                Security Act (42 U.S.C. 1396a(a)), as amended by section 
                2001(d), is amended--
                          (i) in paragraph 4), by striking ``and'' at 
                      the end;
                          (ii) in paragraph (75), by striking the period 
                      at the end and inserting ``; and''; and
                          (iii) by inserting after paragraph (75) the 
                      following new paragraph:
            ``(76) provide that any data collected under the State plan 
        meets the requirements of section 3101 of the Public Health 
        Service Act.''.
                    (B) CHIP.--Section 2108(e) of the Social Security 
                Act (42 U.S.C. 1397hh(e)) is amended by adding at the 
                end the following new paragraph:
            ``(7) Data collected and reported in accordance with section 
        3101 of the Public Health Service Act, with respect to 
        individuals enrolled in the State child health plan (and, in the 
        case of enrollees under 19 years of age, their parents or legal 
        guardians), including data regarding the primary language of 
        such individuals, parents, and legal guardians.''.
            (2) Extending medicare requirement to address health 
        disparities data collection to medicaid and chip.--Title XIX of 
        the Social Security Act (42 U.S.C. 1396 et seq.), as amended by 
        section 2703 is amended by adding at the end the following new 
        section:

[[Page 124 STAT. 582]]

``SEC. 1946. <<NOTE: 42 USC 1396w-5.>> ADDRESSING HEALTH CARE 
            DISPARITIES.

    ``(a) Evaluating Data Collection Approaches.--The Secretary shall 
evaluate approaches for the collection of data under this title and 
title XXI, to be performed in conjunction with existing quality 
reporting requirements and programs under this title and title XXI, that 
allow for the ongoing, accurate, and timely collection and evaluation of 
data on disparities in health care services and performance on the basis 
of race, ethnicity, sex, primary language, and disability status. In 
conducting such evaluation, the Secretary shall consider the following 
objectives:
            ``(1) Protecting patient privacy.
            ``(2) Minimizing the administrative burdens of data 
        collection and reporting on States, providers, and health plans 
        participating under this title or title XXI.
            ``(3) Improving program data under this title and title XXI 
        on race, ethnicity, sex, primary language, and disability 
        status.

    ``(b) Reports to Congress.--
            ``(1) Report on evaluation.--Not later than 18 months after 
        the date of the enactment of this section, the Secretary shall 
        submit to Congress a report on the evaluation conducted under 
        subsection (a). Such report shall, taking into consideration the 
        results of such evaluation--
                    ``(A) identify approaches (including defining 
                methodologies) for identifying and collecting and 
                evaluating data on health care disparities on the basis 
                of race, ethnicity, sex, primary language, and 
                disability status for the programs under this title and 
                title XXI; and
                    ``(B) include recommendations on the most effective 
                strategies and approaches to reporting HEDIS quality 
                measures as required under section 1852(e)(3) and other 
                nationally recognized quality performance measures, as 
                appropriate, on such bases.
            ``(2) Reports on data analyses.--Not later than 4 years 
        after the date of the enactment of this section, and 4 years 
        thereafter, the Secretary shall submit to Congress a report that 
        includes recommendations for improving the identification of 
        health care disparities for beneficiaries under this title and 
        under title XXI based on analyses of the data collected under 
        subsection (c).

    ``(c) Implementing <<NOTE: Deadline.>> Effective Approaches.--Not 
later than 24 months after the date of the enactment of this section, 
the Secretary shall implement the approaches identified in the report 
submitted under subsection (b)(1) for the ongoing, accurate, and timely 
collection and evaluation of data on health care disparities on the 
basis of race, ethnicity, sex, primary language, and disability 
status.''.

SEC. 4303. CDC AND EMPLOYER-BASED WELLNESS PROGRAMS.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), 
by section 4102, is further amended by adding at the end the following:

[[Page 124 STAT. 583]]

                ``PART U--EMPLOYER-BASED WELLNESS PROGRAM

``SEC. 399MM. <<NOTE: 42 USC 280l.>> TECHNICAL ASSISTANCE FOR EMPLOYER-
            BASED WELLNESS PROGRAMS.

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

``SEC. 399MM-1. <<NOTE: 42 USC 280l-1.>> NATIONAL WORKSITE HEALTH 
            POLICIES AND PROGRAMS STUDY.

    ``(a) In <<NOTE: Deadline. Determination.>> 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. <<NOTE: 42 USC 280l-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. <<NOTE: 42 USC 280l-3.>> PROHIBITION OF FEDERAL 
            WORKPLACE WELLNESS REQUIREMENTS.

    ``Notwithstanding any other provision of this part, any 
recommendations, data, or assessments carried out under this part

[[Page 124 STAT. 584]]

shall not be used to mandate requirements for workplace wellness 
programs.''.

SEC. 4304. 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. <<NOTE: 42 USC 300hh-31.>> 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. 4305. ADVANCING RESEARCH AND TREATMENT FOR PAIN CARE MANAGEMENT.

    (a) Institute of Medicine Conference on Pain.--
            (1) Convening.--Not <<NOTE: Deadline. Contracts.>> 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'').

[[Page 124 STAT. 585]]

            (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. <<NOTE: 42 USC 284q.>> 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 <<NOTE: Deadline.>> 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.

[[Page 124 STAT. 586]]

            ``(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 <<NOTE: 42 USC 294i.>> 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.

[[Page 124 STAT. 587]]

    ``(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--
            ``(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 <<NOTE: Grants. Contracts.>> 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. 4306. 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. 4401. 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.

[[Page 124 STAT. 588]]

SEC. 4402. 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 <<NOTE: Evaluation.>> 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) <<NOTE: Reports.>> 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.