TITLE V--HEALTH CARE WORKFORCE

                   Subtitle A--Purpose and Definitions

SEC. 5001. <<NOTE: 42 USC 294q note.>> PURPOSE.

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

SEC. 5002. <<NOTE: 42 USC 294q note.>> DEFINITIONS.

    (a) This Title.--In this title:
            (1) Allied health professional.--The term ``allied health 
        professional'' means an allied health professional as defined in 
        section 799B(5) of the Public Heath Service Act (42 U.S.C. 
        295p(5)) who--
                    (A) has graduated and received an allied health 
                professions degree or certificate from an institution of 
                higher education; and
                    (B) is employed with a Federal, State, local or 
                tribal public health agency, or in a setting where 
                patients might require health care services, including 
                acute care facilities, ambulatory care facilities, 
                personal residences, and other

[[Page 124 STAT. 589]]

                settings located in health professional shortage areas, 
                medically underserved areas, or medically underserved 
                populations, as recognized by the Secretary of Health 
                and Human Services.
            (2) Health care career pathway.--The term ``healthcare 
        career pathway'' means a rigorous, engaging, and high quality 
        set of courses and services that--
                    (A) includes an articulated sequence of academic and 
                career courses, including 21st century skills;
                    (B) is aligned with the needs of healthcare 
                industries in a region or State;
                    (C) prepares students for entry into the full range 
                of postsecondary education options, including registered 
                apprenticeships, and careers;
                    (D) provides academic and career counseling in 
                student-to-counselor ratios that allow students to make 
                informed decisions about academic and career options;
                    (E) meets State academic standards, State 
                requirements for secondary school graduation and is 
                aligned with requirements for entry into postsecondary 
                education, and applicable industry standards; and
                    (F) leads to 2 or more credentials, including--
                          (i) a secondary school diploma; and
                          (ii) a postsecondary degree, an apprenticeship 
                      or other occupational certification, a 
                      certificate, or a license.
            (3) Institution of higher education.--The term ``institution 
        of higher education'' has the meaning given the term in sections 
        101 and 102 of the Higher Education Act of 1965 (20 U.S.C. 1001 
        and 1002).
            (4) Low income individual, state workforce investment board, 
        and local workforce investment board.--
                    (A) Low-income individual.--The term ``low-income 
                individual'' has the meaning given that term in section 
                101 of the Workforce investment Act of 1998 (29 U.S.C. 
                2801).
                    (B) State workforce investment board; local 
                workforce investment board.--The terms ``State workforce 
                investment board'' and ``local workforce investment 
                board'', refer to a State workforce investment board 
                established under section 111 of the Workforce 
                Investment Act of 1998 (29 U.S.C. 2821) and a local 
                workforce investment board established under section 117 
                of such Act (29 U.S.C. 2832), respectively.
            (5) Postsecondary education.--The term ``postsecondary 
        education'' means--
                    (A) a 4-year program of instruction, or not less 
                than a 1-year program of instruction that is acceptable 
                for credit toward an associate or a baccalaureate 
                degree, offered by an institution of higher education; 
                or
                    (B) a certificate or registered apprenticeship 
                program at the postsecondary level offered by an 
                institution of higher education or a non-profit 
                educational institution.
            (6) Registered apprenticeship program.--The term 
        ``registered apprenticeship program'' means an industry skills 
        training program at the postsecondary level that combines 
        technical and theoretical training through structure on the job

[[Page 124 STAT. 590]]

        learning with related instruction (in a classroom or through 
        distance learning) while an individual is employed, working 
        under the direction of qualified personnel or a mentor, and 
        earning incremental wage increases aligned to enhance job 
        proficiency, resulting in the acquisition of a nationally 
        recognized and portable certificate, under a plan approved by 
        the Office of Apprenticeship or a State agency recognized by the 
        Department of Labor.

    (b) Title VII of the Public Health Service Act.--Section 799B of the 
Public Health Service Act (42 U.S.C. 295p) is amended--
            (1) by striking paragraph (3) and inserting the following:
            ``(3) Physician assistant education program.--The term 
        `physician assistant education program' means an educational 
        program in a public or private institution in a State that--
                    ``(A) has as its objective the education of 
                individuals who, upon completion of their studies in the 
                program, be qualified to provide primary care medical 
                services with the supervision of a physician; and
                    ``(B) is accredited by the Accreditation Review 
                Commission on Education for the Physician Assistant.''; 
                and
            (2) by adding at the end the following:
            ``(12) Area health education center.--The term `area health 
        education center' means a public or nonprofit private 
        organization that has a cooperative agreement or contract in 
        effect with an entity that has received an award under 
        subsection (a)(1) or (a)(2) of section 751, satisfies the 
        requirements in section 751(d)(1), and has as one of its 
        principal functions the operation of an area health education 
        center. Appropriate organizations may include hospitals, health 
        organizations with accredited primary care training programs, 
        accredited physician assistant educational programs associated 
        with a college or university, and universities or colleges not 
        operating a school of medicine or osteopathic medicine.
            ``(13) Area health education center program.--The term `area 
        health education center program' means cooperative program 
        consisting of an entity that has received an award under 
        subsection (a)(1) or (a)(2) of section 751 for the purpose of 
        planning, developing, operating, and evaluating an area health 
        education center program and one or more area health education 
        centers, which carries out the required activities described in 
        section 751(c), satisfies the program requirements in such 
        section, has as one of its principal functions identifying and 
        implementing strategies and activities that address health care 
        workforce needs in its service area, in coordination with the 
        local workforce investment boards.
            ``(14) Clinical social worker.--The term `clinical social 
        worker' has the meaning given the term in section 1861(hh)(1) of 
        the Social Security Act (42 U.S.C. 1395x(hh)(1)).
            ``(15) Cultural competency.--The term `cultural competency' 
        shall be defined by the Secretary in a manner consistent with 
        section 1707(d)(3).
            ``(16) Direct care worker.--The term `direct care worker' 
        has the meaning given that term in the 2010 Standard 
        Occupational Classifications of the Department of Labor for Home 
        Health Aides [31-1011], Psychiatric Aides [31-1013], Nursing 
        Assistants [31-1014], and Personal Care Aides [39-9021].

[[Page 124 STAT. 591]]

            ``(17) Federally qualified health center.--The term 
        `Federally qualified health center' has the meaning given that 
        term in section 1861(aa) of the Social Security Act (42 U.S.C. 
        1395x(aa)).
            ``(18) Frontier health professional shortage area.--The term 
        `frontier health professional shortage area' means an area--
                    ``(A) with a population density less than 6 persons 
                per square mile within the service area; and
                    ``(B) with respect to which the distance or time for 
                the population to access care is excessive.
            ``(19) Graduate psychology.--The term `graduate psychology' 
        means an accredited program in professional psychology.
            ``(20) Health disparity population.--The term `health 
        disparity population' has the meaning given such term in section 
        903(d)(1).
            ``(21) Health literacy.--The term `health literacy' means 
        the degree to which an individual has the capacity to obtain, 
        communicate, process, and understand health information and 
        services in order to make appropriate health decisions.
            ``(22) Mental health service professional.--The term `mental 
        health service professional' means an individual with a graduate 
        or postgraduate degree from an accredited institution of higher 
        education in psychiatry, psychology, school psychology, 
        behavioral pediatrics, psychiatric nursing, social work, school 
        social work, substance abuse disorder prevention and treatment, 
        marriage and family counseling, school counseling, or 
        professional counseling.
            ``(23) One-stop delivery system center.--The term `one-stop 
        delivery system' means a one-stop delivery system described in 
        section 134(c) of the Workforce Investment Act of 1998 (29 
        U.S.C. 2864(c)).
            ``(24) Paraprofessional child and adolescent mental health 
        worker.--The term `paraprofessional child and adolescent mental 
        health worker' means an individual who is not a mental or 
        behavioral health service professional, but who works at the 
        first stage of contact with children and families who are 
        seeking mental or behavioral health services, including 
        substance abuse prevention and treatment services.
            ``(25) Racial and ethnic minority group; racial and ethnic 
        minority population.--The terms `racial and ethnic minority 
        group' and `racial and ethnic minority population' have the 
        meaning given the term `racial and ethnic minority group' in 
        section 1707.
            ``(26) Rural health clinic.--The term `rural health clinic' 
        has the meaning given that term in section 1861(aa) of the 
        Social Security Act (42 U.S.C. 1395x(aa)).''.

    (c) Title VIII of the Public Health Service Act.--Section 801 of the 
Public Health Service Act (42 U.S.C. 296) is amended--
            (1) in paragraph (2)--
                    (A) by striking ``means a'' and inserting ``means an 
                accredited (as defined in paragraph 6)''; and
                    (B) by striking the period as inserting the 
                following: ``where graduates are--
                    ``(A) authorized to sit for the National Council 
                Licensure EXamination-Registered Nurse (NCLEX-RN); or

[[Page 124 STAT. 592]]

                    ``(B) licensed registered nurses who will receive a 
                graduate or equivalent degree or training to become an 
                advanced education nurse as defined by section 
                811(b).''; and
            (2) by adding at the end the following:
            ``(16) Accelerated nursing degree program.--The term 
        `accelerated nursing degree program' means a program of 
        education in professional nursing offered by an accredited 
        school of nursing in which an individual holding a bachelors 
        degree in another discipline receives a BSN or MSN degree in an 
        accelerated time frame as determined by the accredited school of 
        nursing.
            ``(17) Bridge or degree completion program.--The term 
        `bridge or degree completion program' means a program of 
        education in professional nursing offered by an accredited 
        school of nursing, as defined in paragraph (2), that leads to a 
        baccalaureate degree in nursing. Such programs may include, 
        Registered Nurse (RN) to Bachelor's of Science of Nursing (BSN) 
        programs, RN to MSN (Master of Science of Nursing) programs, or 
        BSN to Doctoral programs.''.

          Subtitle B--Innovations in the Health Care Workforce

SEC. 5101. <<NOTE: 42 USC 294q.>> NATIONAL HEALTH CARE WORKFORCE 
            COMMISSION.

    (a) Purpose.--It is the purpose of this section to establish a 
National Health Care Workforce Commission that--
            (1) serves as a national resource for Congress, the 
        President, States, and localities;
            (2) communicates and coordinates with the Departments of 
        Health and Human Services, Labor, Veterans Affairs, Homeland 
        Security, and Education on related activities administered by 
        one or more of such Departments;
            (3) develops and commissions evaluations of education and 
        training activities to determine whether the demand for health 
        care workers is being met;
            (4) identifies barriers to improved coordination at the 
        Federal, State, and local levels and recommend ways to address 
        such barriers; and
            (5) encourages innovations to address population needs, 
        constant changes in technology, and other environmental factors.

    (b) Establishment.--There is hereby established the National Health 
Care Workforce Commission (in this section referred to as the 
``Commission'').
    (c) Membership.--
            (1) Number and appointment.--The Commission shall be 
        composed of 15 members to be appointed by the Comptroller 
        General, without regard to section 5 of the Federal Advisory 
        Committee Act (5 U.S.C. App.).
            (2) Qualifications.--
                    (A) In general.--The membership of the Commission 
                shall include individuals--
                          (i) with national recognition for their 
                      expertise in health care labor market analysis, 
                      including health care workforce analysis; health 
                      care finance and

[[Page 124 STAT. 593]]

                      economics; health care facility management; health 
                      care plans and integrated delivery systems; health 
                      care workforce education and training; health care 
                      philanthropy; providers of health care services; 
                      and other related fields; and
                          (ii) who will provide a combination of 
                      professional perspectives, broad geographic 
                      representation, and a balance between urban, 
                      suburban, rural, and frontier representatives.
                    (B) Inclusion.--
                          (i) In general.--The membership of the 
                      Commission shall include no less than one 
                      representative of--
                                    (I) the health care workforce and 
                                health professionals;
                                    (II) employers;
                                    (III) third-party payers;
                                    (IV) individuals skilled in the 
                                conduct and interpretation of health 
                                care services and health economics 
                                research;
                                    (V) representatives of consumers;
                                    (VI) labor unions;
                                    (VII) State or local workforce 
                                investment boards; and
                                    (VIII) educational institutions 
                                (which may include elementary and 
                                secondary institutions, institutions of 
                                higher education, including 2 and 4 year 
                                institutions, or registered 
                                apprenticeship programs).
                          (ii) Additional members.--The remaining 
                      membership may include additional representatives 
                      from clause (i) and other individuals as 
                      determined appropriate by the Comptroller General 
                      of the United States.
                    (C) Majority non-providers.--Individuals who are 
                directly involved in health professions education or 
                practice shall not constitute a majority of the 
                membership of the Commission.
                    (D) Ethical <<NOTE: Public 
                information.>> disclosure.--The Comptroller General 
                shall establish a system for public disclosure by 
                members of the Commission of financial and other 
                potential conflicts of interest relating to such 
                members. Members of the Commission shall be treated as 
                employees of Congress for purposes of applying title I 
                of the Ethics in Government Act of 1978. Members of the 
                Commission shall not be treated as special government 
                employees under title 18, United States Code.
            (3) Terms.--
                    (A) In general.--The terms of members of the 
                Commission shall be for 3 years except that the 
                Comptroller General shall designate staggered terms for 
                the members first appointed.
                    (B) Vacancies.--Any member appointed to fill a 
                vacancy occurring before the expiration of the term for 
                which the member's predecessor was appointed shall be 
                appointed only for the remainder of that term. A member 
                may serve after the expiration of that member's term 
                until a successor has taken office. A vacancy in the 
                Commission

[[Page 124 STAT. 594]]

                shall be filled in the manner in which the original 
                appointment was made.
                    (C) Initial appointments.--
                The <<NOTE: Deadline.>> Comptroller General shall make 
                initial appointments of members to the Commission not 
                later than September 30, 2010.
            (4) Compensation.--While serving on the business of the 
        Commission (including travel time), a member of the Commission 
        shall be entitled to compensation at the per diem equivalent of 
        the rate provided for level IV of the Executive Schedule under 
        section 5315 of tile 5, United States Code, and while so serving 
        away from home and the member's regular place of business, a 
        member may be allowed travel expenses, as authorized by the 
        Chairman of the <<NOTE: Applicability.>> Commission. Physicians 
        serving as personnel of the Commission may be provided a 
        physician comparability allowance by the Commission in the same 
        manner as Government physicians may be provided such an 
        allowance by an agency under section 5948 of title 5, United 
        States Code, and for such purpose subsection (i) of such section 
        shall apply to the Commission in the same manner as it applies 
        to the Tennessee Valley Authority. For purposes of pay (other 
        than pay of members of the Commission) and employment benefits, 
        rights, and privileges, all personnel of the Commission shall be 
        treated as if they were employees of the United States Senate. 
        Personnel of the Commission shall not be treated as employees of 
        the Government Accountability Office for any purpose.
            (5) Chairman, vice chairman.--
        The <<NOTE: Designation.>> Comptroller General shall designate a 
        member of the Commission, at the time of appointment of the 
        member, as Chairman and a member as Vice Chairman for that term 
        of appointment, except that in the case of vacancy of the 
        chairmanship or vice chairmanship, the Comptroller General may 
        designate another member for the remainder of that member's 
        term.
            (6) Meetings.--The Commission shall meet at the call of the 
        chairman, but no less frequently than on a quarterly basis.

    (d) Duties.--
            (1) Recognition, dissemination, and communication.--The 
        Commission shall--
                    (A) recognize efforts of Federal, State, and local 
                partnerships to develop and offer health care career 
                pathways of proven effectiveness;
                    (B) disseminate information on promising retention 
                practices for health care professionals; and
                    (C) communicate information on important policies 
                and practices that affect the recruitment, education and 
                training, and retention of the health care workforce.
            (2) Review of health care workforce and annual reports.--In 
        order to develop a fiscally sustainable integrated workforce 
        that supports a high-quality, readily accessible health care 
        delivery system that meets the needs of patients and 
        populations, the Commission, in consultation with relevant 
        Federal, State, and local agencies, shall--
                    (A) review current and projected health care 
                workforce supply and demand, including the topics 
                described in paragraph (3);

[[Page 124 STAT. 595]]

                    (B) make recommendations to Congress and the 
                Administration concerning national health care workforce 
                priorities, goals, and policies;
                    (C) by not later than October 1 of each year 
                (beginning with 2011), submit a report to Congress and 
                the Administration containing the results of such 
                reviews and recommendations concerning related policies; 
                and
                    (D) by not later than April 1 of each year 
                (beginning with 2011), submit a report to Congress and 
                the Administration containing a review of, and 
                recommendations on, at a minimum one high priority area 
                as described in paragraph (4).
            (3) Specific topics to be reviewed.--The topics described in 
        this paragraph include--
                    (A) current health care workforce supply and 
                distribution, including demographics, skill sets, and 
                demands, with projected demands during the subsequent 10 
                and 25 year periods;
                    (B) health care workforce education and training 
                capacity, including the number of students who have 
                completed education and training, including registered 
                apprenticeships; the number of qualified faculty; the 
                education and training infrastructure; and the education 
                and training demands, with projected demands during the 
                subsequent 10 and 25 year periods;
                    (C) the education loan and grant programs in titles 
                VII and VIII of the Public Health Service Act (42 U.S.C. 
                292 et seq. and 296 et seq.), with recommendations on 
                whether such programs should become part of the Higher 
                Education Act of 1965 (20 U.S.C. 1001 et seq);
                    (D) the implications of new and existing Federal 
                policies which affect the health care workforce, 
                including Medicare and Medicaid graduate medical 
                education policies, titles VII and VIII of the Public 
                Health Service Act (42 U.S.C. 292 et seq. and 296 et 
                seq.), the National Health Service Corps (with 
                recommendations for aligning such programs with national 
                health workforce priorities and goals), and other health 
                care workforce programs, including those supported 
                through the Workforce Investment Act of 1998 (29 U.S.C. 
                2801 et seq.), the Carl D. Perkins Career and Technical 
                Education Act of 2006 (20 U.S.C. 2301 et seq.), the 
                Higher Education Act of 1965 (20 U.S.C. 1001 et seq.), 
                and any other Federal health care workforce programs;
                    (E) the health care workforce needs of special 
                populations, such as minorities, rural populations, 
                medically underserved populations, gender specific 
                needs, individuals with disabilities, and geriatric and 
                pediatric populations with recommendations for new and 
                existing Federal policies to meet the needs of these 
                special populations; and
                    (F) recommendations creating or revising national 
                loan repayment programs and scholarship programs to 
                require low-income, minority medical students to serve 
                in their home communities, if designated as medical 
                underserved community.
            (4) High priority areas.--

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                    (A) In general.--The initial high priority topics 
                described in this paragraph include each of the 
                following:
                          (i) Integrated health care workforce planning 
                      that identifies health care professional skills 
                      needed and maximizes the skill sets of health care 
                      professionals across disciplines.
                          (ii) An analysis of the nature, scopes of 
                      practice, and demands for health care workers in 
                      the enhanced information technology and management 
                      workplace.
                          (iii) An analysis of how to align Medicare and 
                      Medicaid graduate medical education policies with 
                      national workforce goals.
                          (iv) The education and training capacity, 
                      projected demands, and integration with the health 
                      care delivery system of each of the following:
                                    (I) Nursing workforce capacity at 
                                all levels.
                                    (II) Oral health care workforce 
                                capacity at all levels.
                                    (III) Mental and behavioral health 
                                care workforce capacity at all levels.
                                    (IV) Allied health and public health 
                                care workforce capacity at all levels.
                                    (V) Emergency medical service 
                                workforce capacity, including the 
                                retention and recruitment of the 
                                volunteer workforce, at all levels.
                                    (VI) The geographic distribution of 
                                health care providers as compared to the 
                                identified health care workforce needs 
                                of States and regions.
                    (B) Future determinations.--The Commission may 
                require that additional topics be included under 
                subparagraph (A). The appropriate committees of Congress 
                may recommend to the Commission the inclusion of other 
                topics for health care workforce development areas that 
                require special attention.
            (5) Grant program.--The Commission shall--
                    (A) review <<NOTE: Review. Reports.>> implementation 
                progress reports on, and report to Congress about, the 
                State Health Care Workforce Development Grant program 
                established in section 5102;
                    (B) in collaboration with the Department of Labor 
                and in coordination with the Department of Education and 
                other relevant Federal agencies, make recommendations to 
                the fiscal and administrative agent under section 
                5102(b) for grant recipients under section 5102;
                    (C) assess the implementation of the grants under 
                such section; and
                    (D) collect performance and report information, 
                including identified models and best practices, on 
                grants from the fiscal and administrative agent under 
                such section and distribute this information to 
                Congress, relevant Federal agencies, and to the public.
            (6) Study.--The Commission shall study effective mechanisms 
        for financing education and training for careers in health care, 
        including public health and allied health.
            (7) Recommendations.--The Commission shall submit 
        recommendations to Congress, the Department of Labor, and the 
        Department of Health and Human Services about improving

[[Page 124 STAT. 597]]

        safety, health, and worker protections in the workplace for the 
        health care workforce.
            (8) Assessment.--The Commission shall assess and receive 
        reports from the National Center for Health Care Workforce 
        Analysis established under section 761(b) of the Public Service 
        Health Act (as amended by section 5103).

    (e) Consultation With Federal, State, and Local Agencies, Congress, 
and Other Organizations.--
            (1) In general.--The Commission shall consult with Federal 
        agencies (including the Departments of Health and Human 
        Services, Labor, Education, Commerce, Agriculture, Defense, and 
        Veterans Affairs and the Environmental Protection Agency), 
        Congress, the Medicare Payment Advisory Commission, the Medicaid 
        and CHIP Payment and Access Commission, and, to the extent 
        practicable, with State and local agencies, Indian tribes, 
        voluntary health care organizations, professional societies, and 
        other relevant public-private health care partnerships.
            (2) Obtaining official data.--The Commission, consistent 
        with established privacy rules, may secure directly from any 
        department or agency of the Executive Branch information 
        necessary to enable the Commission to carry out this section.
            (3) Detail of federal government employees.--An employee of 
        the Federal Government may be detailed to the Commission without 
        reimbursement. The detail of such an employee shall be without 
        interruption or loss of civil service status.

    (f) Director and Staff; Experts and Consultants.--Subject to such 
review as the Comptroller General of the United States determines to be 
necessary to ensure the efficient administration of the Commission, the 
Commission may--
            (1) employ and fix the compensation of an executive director 
        that shall not exceed the rate of basic pay payable for level V 
        of the Executive Schedule and such other personnel as may be 
        necessary to carry out its duties (without regard to the 
        provisions of title 5, United States Code, governing 
        appointments in the competitive service);
            (2) seek such assistance and support as may be required in 
        the performance of its duties from appropriate Federal 
        departments and agencies;
            (3) enter into contracts or make other arrangements, as may 
        be necessary for the conduct of the work of the Commission 
        (without regard to section 3709 of the Revised Statutes (41 
        U.S.C. 5));
            (4) make advance, progress, and other payments which relate 
        to the work of the Commission;
            (5) provide transportation and subsistence for persons 
        serving without compensation; and
            (6) prescribe such rules and regulations as the Commission 
        determines to be necessary with respect to the internal 
        organization and operation of the Commission.

    (g) Powers.--
            (1) Data collection.--In order to carry out its functions 
        under this section, the Commission shall--
                    (A) utilize existing information, both published and 
                unpublished, where possible, collected and assessed 
                either by its own staff or under other arrangements made 
                in

[[Page 124 STAT. 598]]

                accordance with this section, including coordination 
                with the Bureau of Labor Statistics;
                    (B) carry out, or award grants or contracts for the 
                carrying out of, original research and development, 
                where existing information is inadequate, and
                    (C) adopt procedures allowing interested parties to 
                submit information for the Commission's use in making 
                reports and recommendations.
            (2) Access of the government accountability office to 
        information.--The Comptroller General of the United States shall 
        have unrestricted access to all deliberations, records, and data 
        of the Commission, immediately upon request.
            (3) Periodic audit.--The Commission shall be subject to 
        periodic audit by an independent public accountant under 
        contract to the Commission.

    (h) Authorization of Appropriations.--
            (1) Request for appropriations.--The Commission shall submit 
        requests for appropriations in the same manner as the 
        Comptroller General of the United States submits requests for 
        appropriations. Amounts so appropriated for the Commission shall 
        be separate from amounts appropriated for the Comptroller 
        General.
            (2) Authorization.--There are authorized to be appropriated 
        such sums as may be necessary to carry out this section.
            (3) Gifts and services.--The Commission may not accept 
        gifts, bequeaths, or donations of property, but may accept and 
        use donations of services for purposes of carrying out this 
        section.

    (i) Definitions.--In this section:
            (1) Health care workforce.--The term ``health care 
        workforce'' includes all health care providers with direct 
        patient care and support responsibilities, such as physicians, 
        nurses, nurse practitioners, primary care providers, preventive 
        medicine physicians, optometrists, ophthalmologists, physician 
        assistants, pharmacists, dentists, dental hygienists, and other 
        oral healthcare professionals, allied health professionals, 
        doctors of chiropractic, community health workers, health care 
        paraprofessionals, direct care workers, psychologists and other 
        behavioral and mental health professionals (including substance 
        abuse prevention and treatment providers), social workers, 
        physical and occupational therapists, certified nurse midwives, 
        podiatrists, the EMS workforce (including professional and 
        volunteer ambulance personnel and firefighters who perform 
        emergency medical services), licensed complementary and 
        alternative medicine providers, integrative health 
        practitioners, public health professionals, and any other health 
        professional that the Comptroller General of the United States 
        determines appropriate.
            (2) Health professionals.--The term ``health professionals'' 
        includes--
                    (A) dentists, dental hygienists, primary care 
                providers, specialty physicians, nurses, nurse 
                practitioners, physician assistants, psychologists and 
                other behavioral and mental health professionals 
                (including substance abuse prevention and treatment 
                providers), social workers, physical and occupational 
                therapists, public health professionals, clinical

[[Page 124 STAT. 599]]

                pharmacists, allied health professionals, doctors of 
                chiropractic, community health workers, school nurses, 
                certified nurse midwives, podiatrists, licensed 
                complementary and alternative medicine providers, the 
                EMS workforce (including professional and volunteer 
                ambulance personnel and firefighters who perform 
                emergency medical services), and integrative health 
                practitioners;
                    (B) national representatives of health 
                professionals;
                    (C) representatives of schools of medicine, 
                osteopathy, nursing, dentistry, optometry, pharmacy, 
                chiropractic, allied health, educational programs for 
                public health professionals, behavioral and mental 
                health professionals (as so defined), social workers, 
                pharmacists, physical and occupational therapists, oral 
                health care industry dentistry and dental hygiene, and 
                physician assistants;
                    (D) representatives of public and private teaching 
                hospitals, and ambulatory health facilities, including 
                Federal medical facilities; and
                    (E) any other health professional the Comptroller 
                General of the United States determines appropriate.

SEC. 5102. STATE <<NOTE: 42 USC 294r.>> HEALTH CARE WORKFORCE 
            DEVELOPMENT GRANTS.

    (a) Establishment.--There is established a competitive health care 
workforce development grant program (referred to in this section as the 
``program'') for the purpose of enabling State partnerships to complete 
comprehensive planning and to carry out activities leading to coherent 
and comprehensive health care workforce development strategies at the 
State and local levels.
    (b) Fiscal and Administrative Agent.--The Health Resources and 
Services Administration of the Department of Health and Human Services 
(referred to in this section as the ``Administration'') shall be the 
fiscal and administrative agent for the grants awarded under 
this <<NOTE: Review.>> section. The Administration is authorized to 
carry out the program, in consultation with the National Health Care 
Workforce Commission (referred to in this section as the 
``Commission''), which shall review reports on the development, 
implementation, and evaluation activities of the grant program, 
including--
            (1) administering the grants;
            (2) providing technical assistance to grantees; and
            (3) reporting performance information to the Commission.

    (c) Planning Grants.--
            (1) Amount and duration.--A planning grant shall be awarded 
        under this subsection for a period of not more than one year and 
        the maximum award may not be more than $150,000.
            (2) Eligibility.--To be eligible to receive a planning 
        grant, an entity shall be an eligible partnership. An eligible 
        partnership shall be a State workforce investment board, if it 
        includes or modifies the members to include at least one 
        representative from each of the following: health care employer, 
        labor organization, a public 2-year institution of higher 
        education, a public 4-year institution of higher education, the 
        recognized State federation of labor, the State public secondary 
        education agency, the State P-16 or P-20 Council if such a 
        council exists, and a philanthropic organization that is 
        actively engaged in providing learning, mentoring, and work 
        opportunities to recruit,

[[Page 124 STAT. 600]]

        educate, and train individuals for, and retain individuals in, 
        careers in health care and related industries.
            (3) Fiscal and administrative agent.--The Governor of the 
        State receiving a planning grant has the authority to appoint a 
        fiscal and an administrative agency for the partnership.
            (4) Application.--Each State partnership desiring a planning 
        grant shall submit an application to the Administrator of the 
        Administration at such time and in such manner, and accompanied 
        by such information as the Administrator may reasonable require. 
        Each application submitted for a planning grant shall describe 
        the members of the State partnership, the activities for which 
        assistance is sought, the proposed performance benchmarks to be 
        used to measure progress under the planning grant, a budget for 
        use of the funds to complete the required activities described 
        in paragraph (5), and such additional assurance and information 
        as the Administrator determines to be essential to ensure 
        compliance with the grant program requirements.
            (5) Required activities.--A State partnership receiving a 
        planning grant shall carry out the following:
                    (A) Analyze State labor market information in order 
                to create health care career pathways for students and 
                adults, including dislocated workers.
                    (B) Identify current and projected high demand State 
                or regional health care sectors for purposes of planning 
                career pathways.
                    (C) Identify existing Federal, State, and private 
                resources to recruit, educate or train, and retain a 
                skilled health care workforce and strengthen 
                partnerships.
                    (D) Describe the academic and health care industry 
                skill standards for high school graduation, for entry 
                into postsecondary education, and for various 
                credentials and licensure.
                    (E) Describe State secondary and postsecondary 
                education and training policies, models, or practices 
                for the health care sector, including career information 
                and guidance counseling.
                    (F) Identify Federal or State policies or rules to 
                developing a coherent and comprehensive health care 
                workforce development strategy and barriers and a plan 
                to resolve these barriers.
                    (G) Participate in the Administration's evaluation 
                and reporting activities.
            (6) Performance and evaluation.--Before the State 
        partnership receives a planning grant, such partnership and the 
        Administrator of the Administration shall jointly determine the 
        performance benchmarks that will be established for the purposes 
        of the planning grant.
            (7) Match.--Each State partnership receiving a planning 
        grant shall provide an amount, in cash or in kind, that is not 
        less that 15 percent of the amount of the grant, to carry out 
        the activities supported by the grant. The matching requirement 
        may be provided from funds available under other Federal, State, 
        local or private sources to carry out the activities.
            (8) Report.--

[[Page 124 STAT. 601]]

                    (A) Report to administration.--Not later than 1 year 
                after a State partnership receives a planning grant, the 
                partnership shall submit a report to the Administration 
                on the State's performance of the activities under the 
                grant, including the use of funds, including matching 
                funds, to carry out required activities, and a 
                description of the progress of the State workforce 
                investment board in meeting the performance benchmarks.
                    (B) Report to congress.--The Administration shall 
                submit a report to Congress analyzing the planning 
                activities, performance, and fund utilization of each 
                State grant recipient, including an identification of 
                promising practices and a profile of the activities of 
                each State grant recipient.

    (d) Implementation Grants.--
            (1) In general.--The Administration shall--
                    (A) competitively award implementation grants to 
                State partnerships to enable such partnerships to 
                implement activities that will result in a coherent and 
                comprehensive plan for health workforce development that 
                will address current and projected workforce demands 
                within the State; and
                    (B) inform the Commission and Congress about the 
                awards made.
            (2) Duration.--An implementation grant shall be awarded for 
        a period of no more than 2 years, except in those cases where 
        the Administration determines that the grantee is high 
        performing and the activities supported by the grant warrant up 
        to 1 additional year of funding.
            (3) Eligibility.--To be eligible for an implementation 
        grant, a State partnership shall have--
                    (A) received a planning grant under subsection (c) 
                and completed all requirements of such grant; or
                    (B) completed a satisfactory application, including 
                a plan to coordinate with required partners and complete 
                the required activities during the 2 year period of the 
                implementation grant.
            (4) Fiscal and administrative agent.--A State partnership 
        receiving an implementation grant shall appoint a fiscal and an 
        administration agent for the implementation of such grant.
            (5) Application.--Each eligible State partnership desiring 
        an implementation grant shall submit an application to the 
        Administration at such time, in such manner, and accompanied by 
        such information as the Administration may reasonably require. 
        Each application submitted shall include--
                    (A) a description of the members of the State 
                partnership;
                    (B) a description of how the State partnership 
                completed the required activities under the planning 
                grant, if applicable;
                    (C) a description of the activities for which 
                implementation grant funds are sought, including grants 
                to regions by the State partnership to advance coherent 
                and comprehensive regional health care workforce 
                planning activities;
                    (D) a description of how the State partnership will 
                coordinate with required partners and complete the

[[Page 124 STAT. 602]]

                required partnership activities during the duration of 
                an implementation grant;
                    (E) a budget proposal of the cost of the activities 
                supported by the implementation grant and a timeline for 
                the provision of matching funds required;
                    (F) proposed performance benchmarks to be used to 
                assess and evaluate the progress of the partnership 
                activities;
                    (G) a description of how the State partnership will 
                collect data to report progress in grant activities; and
                    (H) such additional assurances as the Administration 
                determines to be essential to ensure compliance with 
                grant requirements.
            (6) Required activities.--
                    (A) In general.--A State partnership that receives 
                an implementation grant may reserve not less than 60 
                percent of the grant funds to make grants to be 
                competitively awarded by the State partnership, 
                consistent with State procurement rules, to encourage 
                regional partnerships to address health care workforce 
                development needs and to promote innovative health care 
                workforce career pathway activities, including career 
                counseling, learning, and employment.
                    (B) Eligible partnership duties.--An eligible State 
                partnership receiving an implementation grant shall--
                          (i) identify and convene regional leadership 
                      to discuss opportunities to engage in statewide 
                      health care workforce development planning, 
                      including the potential use of competitive grants 
                      to improve the development, distribution, and 
                      diversity of the regional health care workforce; 
                      the alignment of curricula for health care 
                      careers; and the access to quality career 
                      information and guidance and education and 
                      training opportunities;
                          (ii) in consultation with key stakeholders and 
                      regional leaders, take appropriate steps to reduce 
                      Federal, State, or local barriers to a 
                      comprehensive and coherent strategy, including 
                      changes in State or local policies to foster 
                      coherent and comprehensive health care workforce 
                      development activities, including health care 
                      career pathways at the regional and State levels, 
                      career planning information, retraining for 
                      dislocated workers, and as appropriate, requests 
                      for Federal program or administrative waivers;
                          (iii) develop, disseminate, and review with 
                      key stakeholders a preliminary statewide strategy 
                      that addresses short- and long-term health care 
                      workforce development supply versus demand;
                          (iv) convene State partnership members on a 
                      regular basis, and at least on a semiannual basis;
                          (v) assist leaders at the regional level to 
                      form partnerships, including technical assistance 
                      and capacity building activities;

[[Page 124 STAT. 603]]

                          (vi) collect and assess data on and report on 
                      the performance benchmarks selected by the State 
                      partnership and the Administration for 
                      implementation activities carried out by regional 
                      and State partnerships; and
                          (vii) participate in the Administration's 
                      evaluation and reporting activities.
            (7) Performance and evaluation.--Before the State 
        partnership receives an implementation grant, it and the 
        Administrator shall jointly determine the performance benchmarks 
        that shall be established for the purposes of the implementation 
        grant.
            (8) Match.--Each State partnership receiving an 
        implementation grant shall provide an amount, in cash or in kind 
        that is not less than 25 percent of the amount of the grant, to 
        carry out the activities supported by the grant. The matching 
        funds may be provided from funds available from other Federal, 
        State, local, or private sources to carry out such activities.
            (9) Reports.--
                    (A) Report to administration.--For each year of the 
                implementation grant, the State partnership receiving 
                the implementation grant shall submit a report to the 
                Administration on the performance of the State of the 
                grant activities, including a description of the use of 
                the funds, including matched funds, to complete 
                activities, and a description of the performance of the 
                State partnership in meeting the performance benchmarks.
                    (B) Report to congress.--The Administration shall 
                submit a report to Congress analyzing implementation 
                activities, performance, and fund utilization of the 
                State grantees, including an identification of promising 
                practices and a profile of the activities of each State 
                grantee.

    (e) Authorization for Appropriations.--
            (1) Planning grants.--There are authorized to be 
        appropriated to award planning grants under subsection (c) 
        $8,000,000 for fiscal year 2010, and such sums as may be 
        necessary for each subsequent fiscal year.
            (2) Implementation grants.--There are authorized to be 
        appropriated to award implementation grants under subsection 
        (d), $150,000,000 for fiscal year 2010, and such sums as may be 
        necessary for each subsequent fiscal year.

SEC. 5103. HEALTH CARE WORKFORCE ASSESSMENT.

    (a) In <<NOTE: 42 USC 294n.>> General.--Section 761 of the Public 
Health Service Act (42 U.S.C. 294m) is amended--
            (1) by redesignating subsection (c) as subsection (e);
            (2) by striking subsection (b) and inserting the following:

    ``(b) National Center for Health Care Workforce Analysis.--
            ``(1) Establishment.--The Secretary shall establish the 
        National Center for Health Workforce Analysis (referred to in 
        this section as the `National Center').
            ``(2) Purposes.--The National Center, in coordination to the 
        extent practicable with the National Health Care Workforce

[[Page 124 STAT. 604]]

        Commission (established in section 5101 of the Patient 
        Protection and Affordable Care Act), and relevant regional and 
        State centers and agencies, shall--
                    ``(A) provide for the development of information 
                describing and analyzing the health care workforce and 
                workforce related issues;
                    ``(B) carry out the activities under section 792(a);
                    ``(C) annually evaluate programs under this title;
                    ``(D) develop and publish performance measures and 
                benchmarks for programs under this title; and
                    ``(E) establish, <<NOTE: Internet 
                registry.>> maintain, and publicize a national Internet 
                registry of each grant awarded under this title and a 
                database to collect data from longitudinal evaluations 
                (as described in subsection (d)(2)) on performance 
                measures (as developed under sections 749(d)(3), 
                757(d)(3), and 762(a)(3)).
            ``(3) Collaboration and data sharing.--
                    ``(A) In general.--The National Center shall 
                collaborate with Federal agencies and relevant 
                professional and educational organizations or societies 
                for the purpose of linking data regarding grants awarded 
                under this title.
                    ``(B) Contracts for health workforce analysis.--For 
                the purpose of carrying out the activities described in 
                subparagraph (A), the National Center may enter into 
                contracts with relevant professional and educational 
                organizations or societies.

    ``(c) State and Regional Centers for Health Workforce Analysis.--
            ``(1) In general.--
        The <<NOTE: Grants. Contracts.>> Secretary shall award grants 
        to, or enter into contracts with, eligible entities for purposes 
        of--
                    ``(A) collecting, analyzing, and reporting data 
                regarding programs under this title to the National 
                Center and to the public; and
                    ``(B) providing technical assistance to local and 
                regional entities on the collection, analysis, and 
                reporting of data.
            ``(2) Eligible entities.--To be eligible for a grant or 
        contract under this subsection, an entity shall--
                    ``(A) be a State, a State workforce investment 
                board, a public health or health professions school, an 
                academic health center, or an appropriate public or 
                private nonprofit entity; and
                    ``(B) submit to the Secretary an application at such 
                time, in such manner, and containing such information as 
                the Secretary may require.

    ``(d) Increase in Grants for Longitudinal Evaluations.--
            ``(1) In general.--The Secretary shall increase the amount 
        awarded to an eligible entity under this title for a 
        longitudinal evaluation of individuals who have received 
        education, training, or financial assistance from programs under 
        this title.
            ``(2) Capability.--A longitudinal evaluation shall be 
        capable of--
                    ``(A) studying practice patterns; and
                    ``(B) collecting and reporting data on performance 
                measures developed under sections 749(d)(3), 757(d)(3), 
                and 762(a)(3).

[[Page 124 STAT. 605]]

            ``(3) Guidelines.--A longitudinal evaluation shall comply 
        with guidelines issued under sections 749(d)(4), 757(d)(4), and 
        762(a)(4).
            ``(4) Eligible entities.--To be eligible to obtain an 
        increase under this section, an entity shall be a recipient of a 
        grant or contract under this title.''; and
            (3) in subsection (e), as so redesignated--
                    (A) by striking paragraph (1) and inserting the 
                following:
            ``(1) In <<NOTE: Appropriation authorization.>> general.--
                    ``(A) National center.--To carry out subsection (b), 
                there are authorized to be appropriated $7,500,000 for 
                each of fiscal years 2010 through 2014.
                    ``(B) State and regional centers.--To carry out 
                subsection (c), there are authorized to be appropriated 
                $4,500,000 for each of fiscal years 2010 through 2014.
                    ``(C) Grants for longitudinal evaluations.--To carry 
                out subsection (d), there are authorized to be 
                appropriated such sums as may be necessary for fiscal 
                years 2010 through 2014.''; and
            (4) in paragraph (2), by striking ``subsection (a)'' and 
        inserting ``paragraph (1)''.

    (b) Transfers.--Not <<NOTE: Deadline. 42 USC 294n note.>> later than 
180 days after the date of enactment of this Act, the responsibilities 
and resources of the National Center for Health Workforce Analysis, as 
in effect on the date before the date of enactment of this Act, shall be 
transferred to the National Center for Health Care Workforce Analysis 
established under section 761 of the Public Health Service Act, as 
amended by subsection (a).

    (c) Use of Longitudinal Evaluations.--Section 791(a)(1) of the 
Public Health Service Act (42 U.S.C. 295j(a)(1)) is amended--
            (1) in subparagraph (A), by striking ``or'' at the end;
            (2) in subparagraph (B), by striking the period and 
        inserting ``; or''; and
            (3) by adding at the end the following:
                    ``(C) utilizes a longitudinal evaluation (as 
                described in section 761(d)(2)) and reports data from 
                such system to the national workforce database (as 
                established under section 761(b)(2)(E)).''.

    (d) Performance Measures; Guidelines for Longitudinal Evaluations.--
            (1) Advisory <<NOTE: 42 USC 293l.>> committee on training in 
        primary care medicine and dentistry.--Section 748(d) of the 
        Public Health Service Act is amended--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following:
            ``(3) develop, publish, and implement performance measures 
        for programs under this part;
            ``(4) develop and publish guidelines for longitudinal 
        evaluations (as described in section 761(d)(2)) for programs 
        under this part; and
            ``(5) recommend appropriation levels for programs under this 
        part.''.

[[Page 124 STAT. 606]]

            (2) Advisory committee on interdisciplinary, community-based 
        linkages.--Section 756(d) of the Public Health Service 
        Act <<NOTE: 42 USC 294f.>> is amended--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following:
            ``(3) develop, publish, and implement performance measures 
        for programs under this part;
            ``(4) develop and publish guidelines for longitudinal 
        evaluations (as described in section 761(d)(2)) for programs 
        under this part; and
            ``(5) recommend appropriation levels for programs under this 
        part.''.
            (3) Advisory council on graduate medical education.--Section 
        762(a) of the Public Health Service Act (42 U.S.C. 294o(a)) is 
        amended--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following:
            ``(3) develop, publish, and implement performance measures 
        for programs under this title, except for programs under part C 
        or D;
            ``(4) develop and publish guidelines for longitudinal 
        evaluations (as described in section 761(d)(2)) for programs 
        under this title, except for programs under part C or D; and
            ``(5) recommend appropriation levels for programs under this 
        title, except for programs under part C or D.''.

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

SEC. 5201. FEDERALLY SUPPORTED STUDENT LOAN FUNDS.

    (a) Medical Schools and Primary Health Care.--Section 723 of the 
Public Health Service Act (42 U.S.C. 292s) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking subparagraph (B) 
                and inserting the following:
                    ``(B) to practice in such care for 10 years 
                (including residency training in primary health care) or 
                through the date on which the loan is repaid in full, 
                whichever occurs first.''; and
                    (B) by striking paragraph (3) and inserting the 
                following:
            ``(3) Noncompliance by student.--Each agreement entered into 
        with a student pursuant to paragraph (1) shall provide that, if 
        the student fails to comply with such agreement, the loan 
        involved will begin to accrue interest at a rate of 2 percent 
        per year greater than the rate at which the student would pay if 
        compliant in such year.''; and
            (2) by adding at the end the following:

    ``(d) Sense of Congress.--It is the sense of Congress that funds 
repaid under the loan program under this section should not be 
transferred to the Treasury of the United States or otherwise used for 
any other purpose other than to carry out this section.''.

[[Page 124 STAT. 607]]

    (b) Student <<NOTE: 42 USC 292s note.>> Loan Guidelines.--The 
Secretary of Health and Human Services shall not require parental 
financial information for an independent student to determine financial 
need under section 723 of the Public Health Service Act (42 U.S.C. 292s) 
and the determination of need for such information shall be at the 
discretion of applicable school loan officer. The Secretary shall amend 
guidelines issued by the Health Resources and Services Administration in 
accordance with the preceding sentence.

SEC. 5202. NURSING STUDENT LOAN PROGRAM.

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

    (b) Loan Provisions.--Section 836(b) of the Public Health Service 
Act (42 U.S.C. 297b(b)) is amended--
            (1) in paragraph (1)(C), by striking ``1986'' and inserting 
        ``2000''; and
            (2) in paragraph (3), by striking ``the date of enactment of 
        the Nurse Training Amendments of 1979'' and inserting 
        ``September 29, 1995''.

SEC. 5203. HEALTH CARE WORKFORCE LOAN REPAYMENT PROGRAMS.

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

             ``Subpart 3--Recruitment and Retention Programs

``SEC. 775. INVESTMENT <<NOTE: 42 USC 295f.>> IN TOMORROW'S PEDIATRIC 
            HEALTH CARE WORKFORCE.

    ``(a) Establishment.--The Secretary shall establish and carry out a 
pediatric specialty loan repayment program under which the eligible 
individual agrees to be employed full-time for a specified period (which 
shall not be less than 2 years) in providing pediatric medical 
subspecialty, pediatric surgical specialty, or child and adolescent 
mental and behavioral health care, including substance abuse prevention 
and treatment services.
    ``(b) Program Administration.--Through <<NOTE: Contracts.>> the 
program established under this section, the Secretary shall enter into 
contracts with qualified health professionals under which--
            ``(1) such qualified health professionals will agree to 
        provide pediatric medical subspecialty, pediatric surgical 
        specialty, or child and adolescent mental and behavioral health 
        care in an area with a shortage of the specified pediatric 
        subspecialty that has a sufficient pediatric population to 
        support such pediatric subspecialty, as determined by the 
        Secretary; and
            ``(2) the Secretary agrees to make payments on the principal 
        and interest of undergraduate, graduate, or graduate medical 
        education loans of professionals described in paragraph (1) of 
        not more than $35,000 a year for each year of agreed upon 
        service under such paragraph for a period of not more than 3 
        years during the qualified health professional's--

[[Page 124 STAT. 608]]

                    ``(A) participation in an accredited pediatric 
                medical subspecialty, pediatric surgical specialty, or 
                child and adolescent mental health subspecialty 
                residency or fellowship; or
                    ``(B) employment as a pediatric medical 
                subspecialist, pediatric surgical specialist, or child 
                and adolescent mental health professional serving an 
                area or population described in such paragraph.

    ``(c) In General.--
            ``(1) Eligible <<NOTE: Definitions.>> individuals.--
                    ``(A) Pediatric medical specialists and pediatric 
                surgical specialists.--For purposes of contracts with 
                respect to pediatric medical specialists and pediatric 
                surgical specialists, the term `qualified health 
                professional' means a licensed physician who--
                          ``(i) is entering or receiving training in an 
                      accredited pediatric medical subspecialty or 
                      pediatric surgical specialty residency or 
                      fellowship; or
                          ``(ii) has completed (but not prior to the end 
                      of the calendar year in which this section is 
                      enacted) the training described in subparagraph 
                      (B).
                    ``(B) Child and adolescent mental and behavioral 
                health.--For purposes of contracts with respect to child 
                and adolescent mental and behavioral health care, the 
                term `qualified health professional' means a health care 
                professional who--
                          ``(i) has received specialized training or 
                      clinical experience in child and adolescent mental 
                      health in psychiatry, psychology, school 
                      psychology, behavioral pediatrics, psychiatric 
                      nursing, social work, school social work, 
                      substance abuse disorder prevention and treatment, 
                      marriage and family therapy, school counseling, or 
                      professional counseling;
                          ``(ii) has a license or certification in a 
                      State to practice allopathic medicine, osteopathic 
                      medicine, psychology, school psychology, 
                      psychiatric nursing, social work, school social 
                      work, marriage and family therapy, school 
                      counseling, or professional counseling; or
                          ``(iii) is a mental health service 
                      professional who completed (but not before the end 
                      of the calendar year in which this section is 
                      enacted) specialized training or clinical 
                      experience in child and adolescent mental health 
                      described in clause (i).
            ``(2) Additional eligibility requirements.--The Secretary 
        may not enter into a contract under this subsection with an 
        eligible individual unless--
                    ``(A) the individual agrees to work in, or for a 
                provider serving, a health professional shortage area or 
                medically underserved area, or to serve a medically 
                underserved population;
                    ``(B) the individual is a United States citizen or a 
                permanent legal United States resident; and
                    ``(C) if the individual is enrolled in a graduate 
                program, the program is accredited, and the individual 
                has an acceptable level of academic standing (as 
                determined by the Secretary).

[[Page 124 STAT. 609]]

    ``(d) Priority.--In entering into contracts under this subsection, 
the Secretary shall give priority to applicants who--
            ``(1) are or will be working in a school or other pre-
        kindergarten, elementary, or secondary education setting;
            ``(2) have familiarity with evidence-based methods and 
        cultural and linguistic competence health care services; and
            ``(3) demonstrate financial need.

    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated $30,000,000 for each of fiscal years 2010 through 2014 to 
carry out subsection (c)(1)(A) and $20,000,000 for each of fiscal years 
2010 through 2013 to carry out subsection (c)(1)(B).''.

SEC. 5204. PUBLIC HEALTH WORKFORCE RECRUITMENT AND RETENTION PROGRAMS.

    Part E of title VII of the Public Health Service Act (42 U.S.C. 294n 
et seq.), as amended by section 5203, is further amended by adding at 
the end the following:

``SEC. 776. PUBLIC <<NOTE: 42 USC 295f-1.>> HEALTH WORKFORCE LOAN 
            REPAYMENT PROGRAM.

    ``(a) Establishment.--The Secretary shall establish the Public 
Health Workforce Loan Repayment Program (referred to in this section as 
the `Program') to assure an adequate supply of public health 
professionals to eliminate critical public health workforce shortages in 
Federal, State, local, and tribal public health agencies.
    ``(b) Eligibility.--To be eligible to participate in the Program, an 
individual shall--
            ``(1)(A) be accepted for enrollment, or be enrolled, as a 
        student in an accredited academic educational institution in a 
        State or territory in the final year of a course of study or 
        program leading to a public health or health professions degree 
        or certificate; and have accepted employment with a Federal, 
        State, local, or tribal public health agency, or a related 
        training fellowship, as recognized by the Secretary, to commence 
        upon graduation;
            ``(B)(i) have graduated, during the preceding 10-year 
        period, from an accredited educational institution in a State or 
        territory and received a public health or health professions 
        degree or certificate; and
            ``(ii) be employed by, or have accepted employment with, a 
        Federal, State, local, or tribal public health agency or a 
        related training fellowship, as recognized by the Secretary;
            ``(2) be a United States citizen; and
            ``(3)(A) submit an application to the Secretary to 
        participate in the Program;
            ``(B) execute a written contract as required in subsection 
        (c); and
            ``(4) not have received, for the same service, a reduction 
        of loan obligations under section 455(m), 428J, 428K, 428L, or 
        460 of the Higher Education Act of 1965.

    ``(c) Contract.--The written contract (referred to in this section 
as the `written contract') between the Secretary and an individual shall 
contain--
            ``(1) an agreement on the part of the Secretary that the 
        Secretary will repay on behalf of the individual loans incurred 
        by the individual in the pursuit of the relevant degree or 
        certificate in accordance with the terms of the contract;
            ``(2) an agreement on the part of the individual that the 
        individual will serve in the full-time employment of a Federal,

[[Page 124 STAT. 610]]

        State, local, or tribal public health agency or a related 
        fellowship program in a position related to the course of study 
        or program for which the contract was awarded for a period of 
        time (referred to in this section as the `period of obligated 
        service') equal to the greater of--
                    ``(A) 3 years; or
                    ``(B) such longer period of time as determined 
                appropriate by the Secretary and the individual;
            ``(3) an agreement, as appropriate, on the part of the 
        individual to relocate to a priority service area (as determined 
        by the Secretary) in exchange for an additional loan repayment 
        incentive amount to be determined by the Secretary;
            ``(4) a provision that any financial obligation of the 
        United States arising out of a contract entered into under this 
        section and any obligation of the individual that is conditioned 
        thereon, is contingent on funds being appropriated for loan 
        repayments under this section;
            ``(5) a statement of the damages to which the United States 
        is entitled, under this section for the individual's breach of 
        the contract; and
            ``(6) such other statements of the rights and liabilities of 
        the Secretary and of the individual, not inconsistent with this 
        section.

    ``(d) Payments.--
            ``(1) In general.--A loan repayment provided for an 
        individual under a written contract under the Program shall 
        consist of payment, in accordance with paragraph (2), on behalf 
        of the individual of the principal, interest, and related 
        expenses on government and commercial loans received by the 
        individual regarding the undergraduate or graduate education of 
        the individual (or both), which loans were made for tuition 
        expenses incurred by the individual.
            ``(2) Payments for years served.--For each year of obligated 
        service that an individual contracts to serve under subsection 
        (c) the Secretary may pay up to $35,000 on behalf of the 
        individual for loans described in paragraph (1). With respect to 
        participants under the Program whose total eligible loans are 
        less than $105,000, the Secretary shall pay an amount that does 
        not exceed \1/3\ of the eligible loan balance for each year of 
        obligated service of the individual.
            ``(3) Tax liability.--For the purpose of providing 
        reimbursements for tax liability resulting from payments under 
        paragraph (2) on behalf of an individual, the Secretary shall, 
        in addition to such payments, make payments to the individual in 
        an amount not to exceed 39 percent of the total amount of loan 
        repayments made for the taxable year involved.

    ``(e) Postponing Obligated Service.--With respect to an individual 
receiving a degree or certificate from a health professions or other 
related school, the date of the initiation of the period of obligated 
service may be postponed as approved by the Secretary.
    ``(f) Breach of Contract.--An <<NOTE: Penalty.>> individual who 
fails to comply with the contract entered into under subsection (c) 
shall be subject to the same financial penalties as provided for under 
section 338E for breaches of loan repayment contracts under section 
338B.

    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $195,000,000 for fiscal

[[Page 124 STAT. 611]]

year 2010, and such sums as may be necessary for each of fiscal years 
2011 through 2015.''.

SEC. 5205. ALLIED HEALTH WORKFORCE RECRUITMENT AND RETENTION PROGRAMS.

    (a) Purpose.--The <<NOTE: 20 USC 1078-11 note.>> purpose of this 
section is to assure an adequate supply of allied health professionals 
to eliminate critical allied health workforce shortages in Federal, 
State, local, and tribal public health agencies or in settings where 
patients might require health care services, including acute care 
facilities, ambulatory care facilities, personal residences and other 
settings, as recognized by the Secretary of Health and Human Services by 
authorizing an Allied Health Loan Forgiveness Program.

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

SEC. 5206. GRANTS FOR STATE AND LOCAL PROGRAMS.

    (a) In General.--Section 765(d) of the Public Health Service Act (42 
U.S.C. 295(d)) is amended--
            (1) in paragraph (7), by striking ``; or'' and inserting a 
        semicolon;
            (2) by redesignating paragraph (8) as paragraph (9); and
            (3) by inserting after paragraph (7) the following:
            ``(8) public health workforce loan repayment programs; or''.

[[Page 124 STAT. 612]]

    (b) Training for Mid-career Public Health Professionals.--Part E of 
title VII of the Public Health Service Act (42 U.S.C. 294n et seq.), as 
amended by section 5204, is further amended by adding at the end the 
following:

``SEC. 777. TRAINING <<NOTE: 42 USC 295f-2.>> FOR MID-CAREER PUBLIC AND 
            ALLIED HEALTH PROFESSIONALS.

    ``(a) In General.--The Secretary may make grants to, or enter into 
contracts with, any eligible entity to award scholarships to eligible 
individuals to enroll in degree or professional training programs for 
the purpose of enabling mid-career professionals in the public health 
and allied health workforce to receive additional training in the field 
of public health and allied health.
    ``(b) <<NOTE: Definitions.>>  Eligibility.--
            ``(1) Eligible entity.--The term `eligible entity' indicates 
        an accredited educational institution that offers a course of 
        study, certificate program, or professional training program in 
        public or allied health or a related discipline, as determined 
        by the Secretary
            ``(2) Eligible individuals.--The term `eligible individuals' 
        includes those individuals employed in public and allied health 
        positions at the Federal, State, tribal, or local level who are 
        interested in retaining or upgrading their education.

    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $60,000,000 for fiscal year 2010 
and such sums as may be necessary for each of fiscal years 2011 through 
2015. Fifty percent of appropriated funds shall be allotted to public 
health mid-career professionals and 50 percent shall be allotted to 
allied health mid-career professionals.''.

SEC. 5207. FUNDING FOR NATIONAL HEALTH SERVICE CORPS.

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

SEC. 5208. NURSE-MANAGED HEALTH CLINICS.

    (a) Purpose.--The <<NOTE: 42 USC 254c-1a note.>> purpose of this 
section is to fund the development and operation of nurse-managed health 
clinics.

[[Page 124 STAT. 613]]

    (b) Grants.--Subpart 1 of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended by inserting after 
section 330A the following:

``SEC. 330A-1. <<NOTE: 42 USC 254c-1a.>> GRANTS TO NURSE-MANAGED HEALTH 
            CLINICS.

    ``(a) Definitions.--
            ``(1) Comprehensive primary health care services.--In this 
        section, the term `comprehensive primary health care services' 
        means the primary health services described in section 
        330(b)(1).
            ``(2) Nurse-managed health clinic.--The term `nurse-managed 
        health clinic' means a nurse-practice arrangement, managed by 
        advanced practice nurses, that provides primary care or wellness 
        services to underserved or vulnerable populations and that is 
        associated with a school, college, university or department of 
        nursing, federally qualified health center, or independent 
        nonprofit health or social services agency.

    ``(b) Authority to Award Grants.--The Secretary shall award grants 
for the cost of the operation of nurse-managed health clinics that meet 
the requirements of this section.
    ``(c) Applications.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be an NMHC; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing--
                    ``(A) assurances that nurses are the major providers 
                of services at the NMHC and that at least 1 advanced 
                practice nurse holds an executive management position 
                within the organizational structure of the NMHC;
                    ``(B) an assurance that the NMHC will continue 
                providing comprehensive primary health care services or 
                wellness services without regard to income or insurance 
                status of the patient for the duration of the grant 
                period; and
                    ``(C) an assurance that, not later than 90 days of 
                receiving a grant under this section, the NMHC will 
                establish a community advisory committee, for which a 
                majority of the members shall be individuals who are 
                served by the NMHC.

    ``(d) Grant Amount.--The <<NOTE: Determination.>> amount of any 
grant made under this section for any fiscal year shall be determined by 
the Secretary, taking into account--
            ``(1) the financial need of the NMHC, considering State, 
        local, and other operational funding provided to the NMHC; and
            ``(2) other factors, as the Secretary determines 
        appropriate.

    ``(e) Authorization of Appropriations.--For the purposes of carrying 
out this section, there are authorized to be appropriated $50,000,000 
for the fiscal year 2010 and such sums as may be necessary for each of 
the fiscal years 2011 through 2014.''.

SEC. 5209. <<NOTE: 42 USC 238f note.>> ELIMINATION OF CAP ON 
            COMMISSIONED CORPS.

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

[[Page 124 STAT. 614]]

SEC. 5210. ESTABLISHING A READY RESERVE CORPS.

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

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

    ``(a) Establishment.--
            ``(1) In general.--There shall be in the Service a 
        commissioned Regular Corps and a Ready Reserve Corps for service 
        in time of national emergency.
            ``(2) Requirement.--All commissioned officers shall be 
        citizens of the United States and shall be appointed without 
        regard to the civil-service laws and compensated without regard 
        to the Classification Act of 1923, as amended.
            ``(3) Appointment.--
        Commissioned <<NOTE: President.>> officers of the Ready Reserve 
        Corps shall be appointed by the President and commissioned 
        officers of the Regular Corps shall be appointed by the 
        President with the advice and consent of the Senate.
            ``(4) Active duty.--Commissioned officers of the Ready 
        Reserve Corps shall at all times be subject to call to active 
        duty by the Surgeon General, including active duty for the 
        purpose of training.
            ``(5) Warrant officers.--Warrant officers may be appointed 
        to the Service for the purpose of providing support to the 
        health and delivery systems maintained by the Service and any 
        warrant officer appointed to the Service shall be considered for 
        purposes of this Act and title 37, United States Code, to be a 
        commissioned officer within the Commissioned Corps of the 
        Service.

    ``(b) Assimilating Reserve Corp Officers Into the Regular Corps.--
Effective <<NOTE: Effective date.>> on the date of enactment of the 
Patient Protection and Affordable Care Act, all individuals classified 
as officers in the Reserve Corps under this section (as such section 
existed on the day before the date of enactment of such Act) and serving 
on active duty shall be deemed to be commissioned officers of the 
Regular Corps.

    ``(c) Purpose and Use of Ready Research.--
            ``(1) Purpose.--The purpose of the Ready Reserve Corps is to 
        fulfill the need to have additional Commissioned Corps personnel 
        available on short notice (similar to the uniformed service's 
        reserve program) to assist regular Commissioned Corps personnel 
        to meet both routine public health and emergency response 
        missions.
            ``(2) Uses.--The Ready Reserve Corps shall--
                    ``(A) participate in routine training to meet the 
                general and specific needs of the Commissioned Corps;
                    ``(B) be available and ready for involuntary calls 
                to active duty during national emergencies and public 
                health crises, similar to the uniformed service reserve 
                personnel;
                    ``(C) be available for backfilling critical 
                positions left vacant during deployment of active duty 
                Commissioned Corps members, as well as for deployment to 
                respond to public health emergencies, both foreign and 
                domestic; and
                    ``(D) be available for service assignment in 
                isolated, hardship, and medically underserved 
                communities (as defined in section 799B) to improve 
                access to health services.

[[Page 124 STAT. 615]]

    ``(d) Funding.--For the purpose of carrying out the duties and 
responsibilities of the Commissioned Corps under this section, there are 
authorized to be appropriated $5,000,000 for each of fiscal years 2010 
through 2014 for recruitment and training and $12,500,000 for each of 
fiscal years 2010 through 2014 for the Ready Reserve Corps.''.

   Subtitle D--Enhancing Health Care Workforce Education and Training

SEC. 5301. TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, 
            GENERAL PEDIATRICS, AND PHYSICIAN ASSISTANTSHIP.

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

``SEC. 747. <<NOTE: 42 USC 293k.>> PRIMARY CARE TRAINING AND 
            ENHANCEMENT.

    ``(a) Support and Development of Primary Care Training Programs.--
            ``(1) In general.--The Secretary may make grants to, or 
        enter into contracts with, an accredited public or nonprofit 
        private hospital, school of medicine or osteopathic medicine, 
        academically affiliated physician assistant training program, or 
        a public or private nonprofit entity which the Secretary has 
        determined is capable of carrying out such grant or contract--
                    ``(A) to plan, develop, operate, or participate in 
                an accredited professional training program, including 
                an accredited residency or internship program in the 
                field of family medicine, general internal medicine, or 
                general pediatrics for medical students, interns, 
                residents, or practicing physicians as defined by the 
                Secretary;
                    ``(B) to provide need-based financial assistance in 
                the form of traineeships and fellowships to medical 
                students, interns, residents, practicing physicians, or 
                other medical personnel, who are participants in any 
                such program, and who plan to specialize or work in the 
                practice of the fields defined in subparagraph (A);
                    ``(C) to plan, develop, and operate a program for 
                the training of physicians who plan to teach in family 
                medicine, general internal medicine, or general 
                pediatrics training programs;
                    ``(D) to plan, develop, and operate a program for 
                the training of physicians teaching in community-based 
                settings;
                    ``(E) to provide financial assistance in the form of 
                traineeships and fellowships to physicians who are 
                participants in any such programs and who plan to teach 
                or conduct research in a family medicine, general 
                internal medicine, or general pediatrics training 
                program;
                    ``(F) to plan, develop, and operate a physician 
                assistant education program, and for the training of 
                individuals who will teach in programs to provide such 
                training;
                    ``(G) to plan, develop, and operate a demonstration 
                program that provides training in new competencies, as 
                recommended by the Advisory Committee on Training in

[[Page 124 STAT. 616]]

                Primary Care Medicine and Dentistry and the National 
                Health Care Workforce Commission established in section 
                5101 of the Patient Protection and Affordable Care Act, 
                which may include--
                          ``(i) providing training to primary care 
                      physicians relevant to providing care through 
                      patient-centered medical homes (as defined by the 
                      Secretary for purposes of this section);
                          ``(ii) developing tools and curricula relevant 
                      to patient-centered medical homes; and
                          ``(iii) providing continuing education to 
                      primary care physicians relevant to patient-
                      centered medical homes; and
                    ``(H) to plan, develop, and operate joint degree 
                programs to provide interdisciplinary and 
                interprofessional graduate training in public health and 
                other health professions to provide training in 
                environmental health, infectious disease control, 
                disease prevention and health promotion, epidemiological 
                studies and injury control.
            ``(2) Duration of awards.--The period during which payments 
        are made to an entity from an award of a grant or contract under 
        this subsection shall be 5 years.

    ``(b) Capacity Building in Primary Care.--
            ``(1) In general.--The Secretary may make grants to or enter 
        into contracts with accredited schools of medicine or 
        osteopathic medicine to establish, maintain, or improve--
                    ``(A) academic units or programs that improve 
                clinical teaching and research in fields defined in 
                subsection (a)(1)(A); or
                    ``(B) programs that integrate academic 
                administrative units in fields defined in subsection 
                (a)(1)(A) to enhance interdisciplinary recruitment, 
                training, and faculty development.
            ``(2) Preference in making awards under this subsection.--In 
        making awards of grants and contracts under paragraph (1), the 
        Secretary shall give preference to any qualified applicant for 
        such an award that agrees to expend the award for the purpose 
        of--
                    ``(A) establishing academic units or programs in 
                fields defined in subsection (a)(1)(A); or
                    ``(B) substantially expanding such units or 
                programs.
            ``(3) Priorities in making awards.--In awarding grants or 
        contracts under paragraph (1), the Secretary shall give priority 
        to qualified applicants that--
                    ``(A) proposes a collaborative project between 
                academic administrative units of primary care;
                    ``(B) proposes innovative approaches to clinical 
                teaching using models of primary care, such as the 
                patient centered medical home, team management of 
                chronic disease, and interprofessional integrated models 
                of health care that incorporate transitions in health 
                care settings and integration physical and mental health 
                provision;
                    ``(C) have a record of training the greatest 
                percentage of providers, or that have demonstrated 
                significant improvements in the percentage of providers 
                trained, who enter and remain in primary care practice;

[[Page 124 STAT. 617]]

                    ``(D) have a record of training individuals who are 
                from underrepresented minority groups or from a rural or 
                disadvantaged background;
                    ``(E) provide training in the care of vulnerable 
                populations such as children, older adults, homeless 
                individuals, victims of abuse or trauma, individuals 
                with mental health or substance-related disorders, 
                individuals with HIV/AIDS, and individuals with 
                disabilities;
                    ``(F) establish formal relationships and submit 
                joint applications with federally qualified health 
                centers, rural health clinics, area health education 
                centers, or clinics located in underserved areas or that 
                serve underserved populations;
                    ``(G) teach trainees the skills to provide 
                interprofessional, integrated care through collaboration 
                among health professionals;
                    ``(H) provide training in enhanced communication 
                with patients, evidence-based practice, chronic disease 
                management, preventive care, health information 
                technology, or other competencies as recommended by the 
                Advisory Committee on Training in Primary Care Medicine 
                and Dentistry and the National Health Care Workforce 
                Commission established in section 5101 of the Patient 
                Protection and Affordable Care Act; or
                    ``(I) provide training in cultural competency and 
                health literacy.
            ``(4) Duration of awards.--The period during which payments 
        are made to an entity from an award of a grant or contract under 
        this subsection shall be 5 years.

    ``(c) Authorization of Appropriations.--
            ``(1) In general.--For purposes of carrying out this section 
        (other than subsection (b)(1)(B)), there are authorized to be 
        appropriated $125,000,000 for fiscal year 2010, and such sums as 
        may be necessary for each of fiscal years 2011 through 2014.
            ``(2) Training programs.--Fifteen percent of the amount 
        appropriated pursuant to paragraph (1) in each such fiscal year 
        shall be allocated to the physician assistant training programs 
        described in subsection (a)(1)(F), which prepare students for 
        practice in primary care.
            ``(3) Integrating academic administrative units.--For 
        purposes of carrying out subsection (b)(1)(B), there are 
        authorized to be appropriated $750,000 for each of fiscal years 
        2010 through 2014.''.

SEC. 5302. TRAINING OPPORTUNITIES FOR DIRECT CARE WORKERS.

    Part C of title VII of the Public Health Service Act (42 U.S.C. 293k 
et seq.) is amended by inserting after section 747, as amended by 
section 5301, the following:

``SEC. 747A. TRAINING <<NOTE: 42 USC 293k-1.>> OPPORTUNITIES FOR DIRECT 
            CARE WORKERS.

    ``(a) In General.--The <<NOTE: Grants.>> Secretary shall award 
grants to eligible entities to enable such entities to provide new 
training opportunities for direct care workers who are employed in long-
term care settings such as nursing homes (as defined in section 
1908(e)(1) of the Social Security Act (42 U.S.C. 1396g(e)(1)), assisted 
living facilities

[[Page 124 STAT. 618]]

and skilled nursing facilities, intermediate care facilities for 
individuals with mental retardation, home and community based settings, 
and any other setting the Secretary determines to be appropriate.

    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be an institution of higher education (as defined in 
        section 102 of the Higher Education Act of 1965 (20 U.S.C. 
        1002)) that--
                    ``(A) is accredited by a nationally recognized 
                accrediting agency or association listed under section 
                101(c) of the Higher Education Act of 1965 (20 U.S.C. 
                1001(c)); and
                    ``(B) has established a public-private educational 
                partnership with a nursing home or skilled nursing 
                facility, agency or entity providing home and community 
                based services to individuals with disabilities, or 
                other long-term care provider; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the Secretary 
        may require.

    ``(c) Use of Funds.--An eligible entity shall use amounts awarded 
under a grant under this section to provide assistance to eligible 
individuals to offset the cost of tuition and required fees for 
enrollment in academic programs provided by such entity.
    ``(d) Eligible Individual.--
            ``(1) Eligibility.--To be eligible for assistance under this 
        section, an individual shall be enrolled in courses provided by 
        a grantee under this subsection and maintain satisfactory 
        academic progress in such courses.
            ``(2) Condition of assistance.--As a condition of receiving 
        assistance under this section, an individual shall agree that, 
        following completion of the assistance period, the individual 
        will work in the field of geriatrics, disability services, long 
        term services and supports, or chronic care management for a 
        minimum of 2 years under guidelines set by the Secretary.

    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $10,000,000 for the period of 
fiscal years 2011 through 2013.''.

SEC. 5303. TRAINING IN GENERAL, PEDIATRIC, AND PUBLIC HEALTH DENTISTRY.

    Part C of Title VII of the Public Health Service Act (42 U.S.C. 293k 
et seq.) is amended by--
            (1) redesignating section 748, <<NOTE: 42 USC 293l.>> as 
        amended by section 5103 of this Act, as section 749; and
            (2) inserting after section 747A, as added by section 5302, 
        the following:

``SEC. 748. <<NOTE: 42 USC 293k-2.>> TRAINING IN GENERAL, PEDIATRIC, AND 
            PUBLIC HEALTH DENTISTRY.

    ``(a) Support and Development of Dental Training Programs.--
            ``(1) In general.--The Secretary may make grants to, or 
        enter into contracts with, a school of dentistry, public or 
        nonprofit private hospital, or a public or private nonprofit 
        entity which the Secretary has determined is capable of carrying 
        out such grant or contract--
                    ``(A) to plan, develop, and operate, or participate 
                in, an approved professional training program in the 
                field

[[Page 124 STAT. 619]]

                of general dentistry, pediatric dentistry, or public 
                health dentistry for dental students, residents, 
                practicing dentists, dental hygienists, or other 
                approved primary care dental trainees, that emphasizes 
                training for general, pediatric, or public health 
                dentistry;
                    ``(B) to provide financial assistance to dental 
                students, residents, practicing dentists, and dental 
                hygiene students who are in need thereof, who are 
                participants in any such program, and who plan to work 
                in the practice of general, pediatric, public heath 
                dentistry, or dental hygiene;
                    ``(C) to plan, develop, and operate a program for 
                the training of oral health care providers who plan to 
                teach in general, pediatric, public health dentistry, or 
                dental hygiene;
                    ``(D) to provide financial assistance in the form of 
                traineeships and fellowships to dentists who plan to 
                teach or are teaching in general, pediatric, or public 
                health dentistry;
                    ``(E) to meet the costs of projects to establish, 
                maintain, or improve dental faculty development programs 
                in primary care (which may be departments, divisions or 
                other units);
                    ``(F) to meet the costs of projects to establish, 
                maintain, or improve predoctoral and postdoctoral 
                training in primary care programs;
                    ``(G) to create a loan repayment program for faculty 
                in dental programs; and
                    ``(H) to provide technical assistance to pediatric 
                training programs in developing and implementing 
                instruction regarding the oral health status, dental 
                care needs, and risk-based clinical disease management 
                of all pediatric populations with an emphasis on 
                underserved children.
            ``(2) Faculty loan repayment.--
                    ``(A) In general.--A grant or contract under 
                subsection (a)(1)(G) may be awarded to a program of 
                general, pediatric, or public health dentistry described 
                in such subsection to plan, develop, and operate a loan 
                repayment program under which--
                          ``(i) individuals agree to serve full-time as 
                      faculty members; and
                          ``(ii) the program of general, pediatric or 
                      public health dentistry agrees to pay the 
                      principal and interest on the outstanding student 
                      loans of the individuals.
                    ``(B) Manner of payments.--With respect to the 
                payments described in subparagraph (A)(ii), upon 
                completion by an individual of each of the first, 
                second, third, fourth, and fifth years of service, the 
                program shall pay an amount equal to 10, 15, 20, 25, and 
                30 percent, respectively, of the individual's student 
                loan balance as calculated based on principal and 
                interest owed at the initiation of the agreement.

    ``(b) Eligible Entity.--For purposes of this subsection, entities 
eligible for such grants or contracts in general, pediatric, or public 
health dentistry shall include entities that have programs in dental or 
dental hygiene schools, or approved residency or advanced education 
programs in the practice of general, pediatric, or public health 
dentistry. Eligible entities may partner with schools of public

[[Page 124 STAT. 620]]

health to permit the education of dental students, residents, and dental 
hygiene students for a master's year in public health at a school of 
public health.
    ``(c) Priorities in Making Awards.--With respect to training 
provided for under this section, the Secretary shall give priority in 
awarding grants or contracts to the following:
            ``(1) Qualified applicants that propose collaborative 
        projects between departments of primary care medicine and 
        departments of general, pediatric, or public health dentistry.
            ``(2) Qualified applicants that have a record of training 
        the greatest percentage of providers, or that have demonstrated 
        significant improvements in the percentage of providers, who 
        enter and remain in general, pediatric, or public health 
        dentistry.
            ``(3) Qualified applicants that have a record of training 
        individuals who are from a rural or disadvantaged background, or 
        from underrepresented minorities.
            ``(4) Qualified applicants that establish formal 
        relationships with Federally qualified health centers, rural 
        health centers, or accredited teaching facilities and that 
        conduct training of students, residents, fellows, or faculty at 
        the center or facility.
            ``(5) Qualified applicants that conduct teaching programs 
        targeting vulnerable populations such as older adults, homeless 
        individuals, victims of abuse or trauma, individuals with mental 
        health or substance-related disorders, individuals with 
        disabilities, and individuals with HIV/AIDS, and in the risk-
        based clinical disease management of all populations.
            ``(6) Qualified applicants that include educational 
        activities in cultural competency and health literacy.
            ``(7) Qualified applicants that have a high rate for placing 
        graduates in practice settings that serve underserved areas or 
        health disparity populations, or who achieve a significant 
        increase in the rate of placing graduates in such settings.
            ``(8) Qualified applicants that intend to establish a 
        special populations oral health care education center or 
        training program for the didactic and clinical education of 
        dentists, dental health professionals, and dental hygienists who 
        plan to teach oral health care for people with developmental 
        disabilities, cognitive impairment, complex medical problems, 
        significant physical limitations, and vulnerable elderly.

    ``(d) Application.--An eligible entity desiring a grant under this 
section shall submit to the Secretary an application at such time, in 
such manner, and containing such information as the Secretary may 
require.
    ``(e) Duration of Award.--The period during which payments are made 
to an entity from an award of a grant or contract under subsection (a) 
shall be 5 years. The provision of such payments shall be subject to 
annual approval by the Secretary and subject to the availability of 
appropriations for the fiscal year involved to make the payments.
    ``(f) Authorizations of Appropriations.--For the purpose of carrying 
out subsections (a) and (b), there is authorized to be appropriated 
$30,000,000 for fiscal year 2010 and such sums as may be necessary for 
each of fiscal years 2011 through 2015.
    ``(g) Carryover Funds.--An entity that receives an award under this 
section may carry over funds from 1 fiscal year to another without 
obtaining approval from the Secretary. In no case

[[Page 124 STAT. 621]]

may any funds be carried over pursuant to the preceding sentence for 
more than 3 years.''.

SEC. 5304. ALTERNATIVE DENTAL HEALTH CARE PROVIDERS DEMONSTRATION 
            PROJECT.

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

``SEC. 340G-1. <<NOTE: 42 USC 256g-1.>> DEMONSTRATION PROGRAM.

    ``(a) In General. <<NOTE: Grants.>> --
            ``(1) Authorization.--The Secretary is authorized to award 
        grants to 15 eligible entities to enable such entities to 
        establish a demonstration program to establish training programs 
        to train, or to employ, alternative dental health care providers 
        in order to increase access to dental health care services in 
        rural and other underserved communities.
            ``(2) Definition.--The term `alternative dental health care 
        providers' includes community dental health coordinators, 
        advance practice dental hygienists, independent dental 
        hygienists, supervised dental hygienists, primary care 
        physicians, dental therapists, dental health aides, and any 
        other health professional that the Secretary determines 
        appropriate.

    ``(b) Timeframe.--The demonstration projects funded under this 
section shall begin not later than 2 years after the date of enactment 
of this section, and shall conclude not later than 7 years after such 
date of enactment.
    ``(c) Eligible Entities.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be--
                    ``(A) an institution of higher education, including 
                a community college;
                    ``(B) a public-private partnership;
                    ``(C) a federally qualified health center;
                    ``(D) an Indian Health Service facility or a tribe 
                or tribal organization (as such terms are defined in 
                section 4 of the Indian Self-Determination and Education 
                Assistance Act);
                    ``(E) a State or county public health clinic, a 
                health facility operated by an Indian tribe or tribal 
                organization, or urban Indian organization providing 
                dental services; or
                    ``(F) a public hospital or health system;
            ``(2) be within a program accredited by the Commission on 
        Dental Accreditation or within a dental education program in an 
        accredited institution; and
            ``(3) shall submit an application to the Secretary at such 
        time, in such manner, and containing such information as the 
        Secretary may require.

    ``(d) Administrative Provisions.--
            ``(1) Amount of grant.--Each grant under this section shall 
        be in an amount that is not less than $4,000,000 for the 5-year 
        period during which the demonstration project being conducted.
            ``(2) Disbursement of funds.--
                    ``(A) Preliminary disbursements. <<NOTE: Effective 
                date.>> --Beginning 1 year after the enactment of this 
                section, the Secretary may disperse to any entity 
                receiving a grant under this section

[[Page 124 STAT. 622]]

                not more than 20 percent of the total funding awarded to 
                such entity under such grant, for the purpose of 
                enabling the entity to plan the demonstration project to 
                be conducted under such grant.
                    ``(B) Subsequent disbursements.--The remaining 
                amount of grant funds not dispersed under subparagraph 
                (A) shall be dispersed such that not less than 15 
                percent of such remaining amount is dispersed each 
                subsequent year.

    ``(e) Compliance With State Requirements.--Each entity receiving a 
grant under this section shall certify that it is in compliance with all 
applicable State licensing requirements.
    ``(f) <<NOTE: Contracts.>> Evaluation.--The Secretary shall contract 
with the Director of the Institute of Medicine to conduct a study of the 
demonstration programs conducted under this section that shall provide 
analysis, based upon quantitative and qualitative data, regarding access 
to dental health care in the United States.

    ``(g) Clarification Regarding Dental Health Aide Program.--Nothing 
in this section shall prohibit a dental health aide training program 
approved by the Indian Health Service from being eligible for a grant 
under this section.
    ``(h) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.''.

SEC. 5305. GERIATRIC EDUCATION AND TRAINING; CAREER AWARDS; 
            COMPREHENSIVE GERIATRIC EDUCATION.

    (a) Workforce Development; Career Awards.--Section 753 of the Public 
Health Service Act (42 U.S.C. 294c) is amended by adding at the end the 
following:
    ``(d) Geriatric Workforce Development.--
            ``(1) In general. <<NOTE: Grants. Contracts.>> --The 
        Secretary shall award grants or contracts under this subsection 
        to entities that operate a geriatric education center pursuant 
        to subsection (a)(1).
            ``(2) Application.--To be eligible for an award under 
        paragraph (1), an entity described in such paragraph shall 
        submit to the Secretary an application at such time, in such 
        manner, and containing such information as the Secretary may 
        require.
            ``(3) Use of funds.--Amounts awarded under a grant or 
        contract under paragraph (1) shall be used to--
                    ``(A) carry out the fellowship program described in 
                paragraph (4); and
                    ``(B) carry out 1 of the 2 activities described in 
                paragraph (5).
            ``(4) Fellowship program.--
                    ``(A) In general.--Pursuant to paragraph (3), a 
                geriatric education center that receives an award under 
                this subsection shall use such funds to offer short-term 
                intensive courses (referred to in this subsection as a 
                `fellowship') that focus on geriatrics, chronic care 
                management, and long-term care that provide supplemental 
                training for faculty members in medical schools and 
                other health professions schools with programs in 
                psychology, pharmacy, nursing, social work, dentistry, 
                public health, allied health, or other health 
                disciplines, as approved by the Secretary. Such a 
                fellowship shall be open to current faculty, and

[[Page 124 STAT. 623]]

                appropriately credentialed volunteer faculty and 
                practitioners, who do not have formal training in 
                geriatrics, to upgrade their knowledge and clinical 
                skills for the care of older adults and adults with 
                functional limitations and to enhance their 
                interdisciplinary teaching skills.
                    ``(B) Location.--A fellowship shall be offered 
                either at the geriatric education center that is 
                sponsoring the course, in collaboration with other 
                geriatric education centers, or at medical schools, 
                schools of dentistry, schools of nursing, schools of 
                pharmacy, schools of social work, graduate programs in 
                psychology, or allied health and other health 
                professions schools approved by the Secretary with which 
                the geriatric education centers are affiliated.
                    ``(C) CME credit.--Participation in a fellowship 
                under this paragraph shall be accepted with respect to 
                complying with continuing health profession education 
                requirements. As a condition of such acceptance, the 
                recipient shall agree to subsequently provide a minimum 
                of 18 hours of voluntary instructional support through a 
                geriatric education center that is providing clinical 
                training to students or trainees in long-term care 
                settings.
            ``(5) Additional required activities described.--Pursuant to 
        paragraph (3), a geriatric education center that receives an 
        award under this subsection shall use such funds to carry out 1 
        of the following 2 activities.
                    ``(A) Family caregiver and direct care provider 
                training.--A geriatric education center that receives an 
                award under this subsection shall offer at least 2 
                courses each year, at no charge or nominal cost, to 
                family caregivers and direct care providers that are 
                designed to provide practical training for supporting 
                frail elders and individuals with 
                disabilities. <<NOTE: Requirements.>> The Secretary 
                shall require such Centers to work with appropriate 
                community partners to develop training program content 
                and to publicize the availability of training courses in 
                their service areas. All family caregiver and direct 
                care provider training programs shall include 
                instruction on the management of psychological and 
                behavioral aspects of dementia, communication techniques 
                for working with individuals who have dementia, and the 
                appropriate, safe, and effective use of medications for 
                older adults.
                    ``(B) Incorporation of best practices.--A geriatric 
                education center that receives an award under this 
                subsection shall develop and include material on 
                depression and other mental disorders common among older 
                adults, medication safety issues for older adults, and 
                management of the psychological and behavioral aspects 
                of dementia and communication techniques with 
                individuals who have dementia in all training courses, 
                where appropriate.
            ``(6) Targets.--A geriatric education center that receives 
        an award under this subsection shall meet targets approved by 
        the Secretary for providing geriatric training to a certain 
        number of faculty or practitioners during the term of the award, 
        as well as other parameters established by the Secretary.
            ``(7) Amount of award.--An award under this subsection shall 
        be in an amount of $150,000. Not more than 24 geriatric 
        education centers may receive an award under this subsection.

[[Page 124 STAT. 624]]

            ``(8) Maintenance of effort.--A geriatric education center 
        that receives an award under this subsection shall provide 
        assurances to the Secretary that funds provided to the geriatric 
        education center under this subsection will be used only to 
        supplement, not to supplant, the amount of Federal, State, and 
        local funds otherwise expended by the geriatric education 
        center.
            ``(9) Authorization of appropriations.--In addition to any 
        other funding available to carry out this section, there is 
        authorized to be appropriated to carry out this subsection, 
        $10,800,000 for the period of fiscal year 2011 through 2014.

    ``(e) Geriatric Career Incentive Awards.--
            ``(1) In general. <<NOTE: Grants. Contracts.>> --The 
        Secretary shall award grants or contracts under this section to 
        individuals described in paragraph (2) to foster greater 
        interest among a variety of health professionals in entering the 
        field of geriatrics, long-term care, and chronic care 
        management.
            ``(2) Eligible individuals.--To be eligible to received an 
        award under paragraph (1), an individual shall--
                    ``(A) be an advanced practice nurse, a clinical 
                social worker, a pharmacist, or student of psychology 
                who is pursuing a doctorate or other advanced degree in 
                geriatrics or related fields in an accredited health 
                professions school; and
                    ``(B) submit to the Secretary an application at such 
                time, in such manner, and containing such information as 
                the Secretary may require.
            ``(3) Condition of award.--As a condition of receiving an 
        award under this subsection, an individual shall agree that, 
        following completion of the award period, the individual will 
        teach or practice in the field of geriatrics, long-term care, or 
        chronic care management for a minimum of 5 years under 
        guidelines set by the Secretary.
            ``(4) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, $10,000,000 for 
        the period of fiscal years 2011 through 2013.''.

    (b) Expansion of Eligibility for Geriatric Academic Career Awards; 
Payment to Institution.--Section 753(c) of the Public Health Service Act 
294(c)) <<NOTE: 42 USC 294c.>> is amended--
            (1) by redesignating paragraphs (4) and (5) as paragraphs 
        (5) and (6), respectively;
            (2) by striking paragraph (2) through paragraph (3) and 
        inserting the following:
            ``(2) Eligible individuals.--To be eligible to receive an 
        Award under paragraph (1), an individual shall--
                    ``(A) be board certified or board eligible in 
                internal medicine, family practice, psychiatry, or 
                licensed dentistry, or have completed any required 
                training in a discipline and employed in an accredited 
                health professions school that is approved by the 
                Secretary;
                    ``(B) have completed an approved fellowship program 
                in geriatrics or have completed specialty training in 
                geriatrics as required by the discipline and any 
                addition geriatrics training as required by the 
                Secretary; and
                    ``(C) have a junior (non-tenured) faculty 
                appointment at an accredited (as determined by the 
                Secretary) school of medicine, osteopathic medicine, 
                nursing, social work,

[[Page 124 STAT. 625]]

                psychology, dentistry, pharmacy, or other allied health 
                disciplines in an accredited health professions school 
                that is approved by the Secretary.
            ``(3) Limitations.--No Award under paragraph (1) may be made 
        to an eligible individual unless the individual--
                    ``(A) has submitted to the Secretary an application, 
                at such time, in such manner, and containing such 
                information as the Secretary may require, and the 
                Secretary has approved such application;
                    ``(B) provides, in such form and manner as the 
                Secretary may require, assurances that the individual 
                will meet the service requirement described in paragraph 
                (6); and
                    ``(C) provides, in such form and manner as the 
                Secretary may require, assurances that the individual 
                has a full-time faculty appointment in a health 
                professions institution and documented commitment from 
                such institution to spend 75 percent of the total time 
                of such individual on teaching and developing skills in 
                interdisciplinary education in geriatrics.
            ``(4) Maintenance of effort.--An eligible individual that 
        receives an Award under paragraph (1) shall provide assurances 
        to the Secretary that funds provided to the eligible individual 
        under this subsection will be used only to supplement, not to 
        supplant, the amount of Federal, State, and local funds 
        otherwise expended by the eligible individual.''; and
            (3) in paragraph (5), as so designated--
                    (A) in subparagraph (A)--
                          (i) by inserting ``for individuals who are 
                      physicians'' after ``this section''; and
                          (ii) <<NOTE: Determination.>> by inserting 
                      after the period at the end the following: ``The 
                      Secretary shall determine the amount of an Award 
                      under this section for individuals who are not 
                      physicians.''; and
                    (B) by adding at the end the following:
                    ``(C) Payment to institution.--The Secretary shall 
                make payments to institutions which include schools of 
                medicine, osteopathic medicine, nursing, social work, 
                psychology, dentistry, and pharmacy, or other allied 
                health discipline in an accredited health professions 
                school that is approved by the Secretary.''.

    (c) Comprehensive Geriatric Education.--Section 855 of the Public 
Health Service Act (42 U.S.C. 298) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (3), by striking ``or'' at the end;
                    (B) in paragraph (4), by striking the period and 
                inserting ``; or''; and
                    (C) by adding at the end the following:
            ``(5) establish traineeships for individuals who are 
        preparing for advanced education nursing degrees in geriatric 
        nursing, long-term care, gero-psychiatric nursing or other 
        nursing areas that specialize in the care of the elderly 
        population.''; and
            (2) in subsection (e), by striking ``2003 through 2007'' and 
        inserting ``2010 through 2014''.

[[Page 124 STAT. 626]]

SEC. 5306. MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS.

    (a) In General.--Part D of title VII (42 U.S.C. 294 et seq.) is 
amended by--
            (1) <<NOTE: 42 USC 294g.>> striking section 757;
            (2) <<NOTE: 42 USC 294f.>> redesignating section 756 (as 
        amended by section 5103) as section 757; and
            (3) inserting after section 755 the following:

``SEC. 756. <<NOTE: 42 USC 294e-1.>> MENTAL AND BEHAVIORAL HEALTH 
            EDUCATION AND TRAINING GRANTS.

    ``(a) Grants Authorized.--The Secretary may award grants to eligible 
institutions of higher education to support the recruitment of students 
for, and education and clinical experience of the students in--
            ``(1) baccalaureate, master's, and doctoral degree programs 
        of social work, as well as the development of faculty in social 
        work;
            ``(2) accredited master's, doctoral, internship, and post-
        doctoral residency programs of psychology for the development 
        and implementation of interdisciplinary training of psychology 
        graduate students for providing behavioral and mental health 
        services, including substance abuse prevention and treatment 
        services;
            ``(3) accredited institutions of higher education or 
        accredited professional training programs that are establishing 
        or expanding internships or other field placement programs in 
        child and adolescent mental health in psychiatry, psychology, 
        school psychology, behavioral pediatrics, psychiatric nursing, 
        social work, school social work, substance abuse prevention and 
        treatment, marriage and family therapy, school counseling, or 
        professional counseling; and
            ``(4) State-licensed mental health nonprofit and for-profit 
        organizations to enable such organizations to pay for programs 
        for preservice or in-service training of paraprofessional child 
        and adolescent mental health workers.

    ``(b) Eligibility Requirements.--To be eligible for a grant under 
this section, an institution shall demonstrate--
            ``(1) participation in the institutions' programs of 
        individuals and groups from different racial, ethnic, cultural, 
        geographic, religious, linguistic, and class backgrounds, and 
        different genders and sexual orientations;
            ``(2) knowledge and understanding of the concerns of the 
        individuals and groups described in subsection (a);
            ``(3) any internship or other field placement program 
        assisted under the grant will prioritize cultural and linguistic 
        competency;
            ``(4) the institution will provide to the Secretary such 
        data, assurances, and information as the Secretary may require; 
        and
            ``(5) with respect to any violation of the agreement between 
        the Secretary and the institution, the institution will pay such 
        liquidated damages as prescribed by the Secretary by regulation.

    ``(c) Institutional Requirement.--For grants authorized under 
subsection (a)(1), at least 4 of the grant recipients shall

[[Page 124 STAT. 627]]

be historically black colleges or universities or other minority-serving 
institutions.
    ``(d) Priority.--
            ``(1) In selecting the grant recipients in social work under 
        subsection (a)(1), the Secretary shall give priority to 
        applicants that--
                    ``(A) are accredited by the Council on Social Work 
                Education;
                    ``(B) have a graduation rate of not less than 80 
                percent for social work students; and
                    ``(C) exhibit an ability to recruit social workers 
                from and place social workers in areas with a high need 
                and high demand population.
            ``(2) In selecting the grant recipients in graduate 
        psychology under subsection (a)(2), the Secretary shall give 
        priority to institutions in which training focuses on the needs 
        of vulnerable groups such as older adults and children, 
        individuals with mental health or substance-related disorders, 
        victims of abuse or trauma and of combat stress disorders such 
        as posttraumatic stress disorder and traumatic brain injuries, 
        homeless individuals, chronically ill persons, and their 
        families.
            ``(3) In selecting the grant recipients in training programs 
        in child and adolescent mental health under subsections (a)(3) 
        and (a)(4), the Secretary shall give priority to applicants 
        that--
                    ``(A) have demonstrated the ability to collect data 
                on the number of students trained in child and 
                adolescent mental health and the populations served by 
                such students after graduation or completion of 
                preservice or in-service training;
                    ``(B) have demonstrated familiarity with evidence-
                based methods in child and adolescent mental health 
                services, including substance abuse prevention and 
                treatment services;
                    ``(C) have programs designed to increase the number 
                of professionals and paraprofessionals serving high-
                priority populations and to applicants who come from 
                high-priority communities and plan to serve medically 
                underserved populations, in health professional shortage 
                areas, or in medically underserved areas;
                    ``(D) offer curriculum taught collaboratively with a 
                family on the consumer and family lived experience or 
                the importance of family-professional or family-
                paraprofessional partnerships; and
                    ``(E) provide services through a community mental 
                health program described in section 1913(b)(1).

    ``(e) Authorization of Appropriation.--For the fiscal years 2010 
through 2013, there is authorized to be appropriated to carry out this 
section--
            ``(1) $8,000,000 for training in social work in subsection 
        (a)(1);
            ``(2) $12,000,000 for training in graduate psychology in 
        subsection (a)(2), of which not less than $10,000,000 shall be 
        allocated for doctoral, postdoctoral, and internship level 
        training;
            ``(3) $10,000,000 for training in professional child and 
        adolescent mental health in subsection (a)(3); and

[[Page 124 STAT. 628]]

            ``(4) $5,000,000 for training in paraprofessional child and 
        adolescent work in subsection (a)(4).''.

    (b) Conforming Amendments.--Section 757(b)(2) of the Public Health 
Service Act, as redesignated by subsection (a) <<NOTE: 42 USC 294f.>> , 
is amended by striking ``sections 751(a)(1)(A), 751(a)(1)(B), 753(b), 
754(3)(A), and 755(b)'' and inserting ``sections 751(b)(1)(A), 753(b), 
and 755(b)''.

SEC. 5307. CULTURAL COMPETENCY, PREVENTION, AND PUBLIC HEALTH AND 
            INDIVIDUALS WITH DISABILITIES TRAINING.

    (a) Title VII.--Section 741 of the Public Health Service Act (42 
U.S.C. 293e) is amended--
            (1) in subsection (a)--
                    (A) by striking the subsection heading and inserting 
                ``Cultural Competency, Prevention, and Public Health and 
                Individuals With Disability Grants''; and
                    (B) in paragraph (1), by striking ``for the purpose 
                of'' and all that follows through the period at the end 
                and inserting ``for the development, evaluation, and 
                dissemination of research, demonstration projects, and 
                model curricula for cultural competency, prevention, 
                public health proficiency, reducing health disparities, 
                and aptitude for working with individuals with 
                disabilities training for use in health professions 
                schools and continuing education programs, and for other 
                purposes determined as appropriate by the Secretary.''; 
                and
            (2) by striking subsection (b) and inserting the following:

    ``(b) Collaboration.--In carrying out subsection (a), the Secretary 
shall collaborate with health professional societies, licensing and 
accreditation entities, health professions schools, and experts in 
minority health and cultural competency, prevention, and public health 
and disability groups, community-based organizations, and other 
organizations as determined appropriate by the Secretary. The Secretary 
shall coordinate with curricula and research and demonstration projects 
developed under section 807.
    ``(c) Dissemination.--
            ``(1) In general.--Model curricula developed under this 
        section shall be disseminated through the Internet Clearinghouse 
        under section 270 and such other means as determined appropriate 
        by the Secretary.
            ``(2) Evaluation.--The Secretary shall evaluate the adoption 
        and the implementation of cultural competency, prevention, and 
        public health, and working with individuals with a disability 
        training curricula, and the facilitate inclusion of these 
        competency measures in quality measurement systems as 
        appropriate.

    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary for 
each of fiscal years 2010 through 2015.''.
    (b) Title VIII.--Section 807 of the Public Health Service Act (42 
U.S.C. 296e-1) is amended--
            (1) in subsection (a)--
                    (A) by striking the subsection heading and inserting 
                ``Cultural Competency, Prevention, and Public Health and 
                Individuals With Disability Grants''; and
                    (B) by striking ``for the purpose of'' and all that 
                follows through ``health care.'' and inserting ``for the 
                development,

[[Page 124 STAT. 629]]

                evaluation, and dissemination of research, demonstration 
                projects, and model curricula for cultural competency, 
                prevention, public health proficiency, reducing health 
                disparities, and aptitude for working with individuals 
                with disabilities training for use in health professions 
                schools and continuing education programs, and for other 
                purposes determined as appropriate by the Secretary.''; 
                and
            (2) by redesignating subsection (b) as subsection (d);
            (3) by inserting after subsection (a) the following:

    ``(b) Collaboration.--In carrying out subsection (a), the Secretary 
shall collaborate with the entities described in section 741(b). The 
Secretary shall coordinate with curricula and research and demonstration 
projects developed under such section 741.
    ``(c) Dissemination.--Model curricula developed under this section 
shall be disseminated and evaluated in the same manner as model 
curricula developed under section 741, as described in subsection (c) of 
such section.''; and
            (4) in subsection (d), as so redesignated--
                    (A) by striking ``subsection (a)'' and inserting 
                ``this section''; and
                    (B) by striking ``2001 through 2004'' and inserting 
                ``2010 through 2015''.

SEC. 5308. ADVANCED NURSING EDUCATION GRANTS.

    Section 811 of the Public Health Service Act (42 U.S.C. 296j) is 
amended--
            (1) in subsection (c)--
                    (A) in the subsection heading, by striking ``and 
                Nurse Midwifery Programs''; and
                    (B) by striking ``and nurse midwifery'';
            (2) in subsection (f)--
                    (A) by striking paragraph (2); and
                    (B) by redesignating paragraph (3) as paragraph (2); 
                and
            (3) by redesignating subsections (d), (e), and (f) as 
        subsections (e), (f), and (g), respectively; and
            (4) by inserting after subsection (c), the following:

    ``(d) Authorized Nurse-midwifery Programs.--Midwifery programs that 
are eligible for support under this section are educational programs 
that--
            ``(1) have as their objective the education of midwives; and
            ``(2) are accredited by the American College of Nurse-
        Midwives Accreditation Commission for Midwifery Education.''.

SEC. 5309. NURSE EDUCATION, PRACTICE, AND RETENTION GRANTS.

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

[[Page 124 STAT. 630]]

            (5) in subsection (h), by striking ``2003 through 2007'' and 
        inserting ``2010 through 2014''.

    (b) Nurse Retention Grants.--Title VIII of the Public Health Service 
Act is amended by inserting after section 831 (42 U.S.C. 296b) the 
following:

``SEC. 831A. <<NOTE: 42 USC 296p-1.>> NURSE RETENTION GRANTS.

    ``(a) Retention Priority Areas.--The Secretary may award grants to, 
and enter into contracts with, eligible entities to enhance the nursing 
workforce by initiating and maintaining nurse retention programs 
pursuant to subsection (b) or (c).
    ``(b) Grants for Career Ladder Program.--The Secretary may award 
grants to, and enter into contracts with, eligible entities for 
programs--
            ``(1) to promote career advancement for individuals 
        including licensed practical nurses, licensed vocational nurses, 
        certified nurse assistants, home health aides, diploma degree or 
        associate degree nurses, to become baccalaureate prepared 
        registered nurses or advanced education nurses in order to meet 
        the needs of the registered nurse workforce;
            ``(2) developing and implementing internships and residency 
        programs in collaboration with an accredited school of nursing, 
        as defined by section 801(2), to encourage mentoring and the 
        development of specialties; or
            ``(3) to assist individuals in obtaining education and 
        training required to enter the nursing profession and advance 
        within such profession.

    ``(c) Enhancing Patient Care Delivery Systems.--
            ``(1) Grants.--The Secretary may award grants to eligible 
        entities to improve the retention of nurses and enhance patient 
        care that is directly related to nursing activities by enhancing 
        collaboration and communication among nurses and other health 
        care professionals, and by promoting nurse involvement in the 
        organizational and clinical decision-making processes of a 
        health care facility.
            ``(2) Priority.--In making awards of grants under this 
        subsection, the Secretary shall give preference to applicants 
        that have not previously received an award under this subsection 
        (or section 831(c) as such section existed on the day before the 
        date of enactment of this section).
            ``(3) Continuation of an award.--The Secretary shall make 
        continuation of any award under this subsection beyond the 
        second year of such award contingent on the recipient of such 
        award having demonstrated to the Secretary measurable and 
        substantive improvement in nurse retention or patient care.

    ``(d) Other Priority Areas.--The Secretary may award grants to, or 
enter into contracts with, eligible entities to address other areas that 
are of high priority to nurse retention, as determined by the Secretary.
    ``(e) Report.--The Secretary shall submit to the Congress before the 
end of each fiscal year a report on the grants awarded and the contracts 
entered into under this section. Each such report shall identify the 
overall number of such grants and contracts and provide an explanation 
of why each such grant or contract will meet the priority need of the 
nursing workforce.

[[Page 124 STAT. 631]]

    ``(f) Eligible Entity.--For purposes of this section, the term 
`eligible entity' includes an accredited school of nursing, as defined 
by section 801(2), a health care facility, or a partnership of such a 
school and facility.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary for 
each of fiscal years 2010 through 2012.''.

SEC. 5310. LOAN REPAYMENT AND SCHOLARSHIP PROGRAM.

    (a) Loan Repayments and Scholarships.--Section 846(a)(3) of the 
Public Health Service Act (42 U.S.C. 297n(a)(3)) is amended by inserting 
before the semicolon the following: ``, or in a accredited school of 
nursing, as defined by section 801(2), as nurse faculty''.
    (b) Technical and Conforming Amendments.--Title VIII (42 U.S.C. 296 
et seq.) is amended--
            (1) by redesignating section 810 <<NOTE: 42 USC 
        296g.>> (relating to prohibition against discrimination by 
        schools on the basis of sex) as section 809 and moving such 
        section so that it follows section 808;
            (2) in sections 835, 836, 838, 840, and 842, <<NOTE: 42 USC 
        297a, 297b, 297d, 297g, 297i.>>  by striking the term ``this 
        subpart'' each place it appears and inserting ``this part'';
            (3) in section 836(h), <<NOTE: 42 USC 297b.>> by striking 
        the last sentence;
            (4) in section 836, by redesignating subsection (l) as 
        subsection (k);
            (5) in section 839, <<NOTE: 42 USC 297e.>> by striking 
        ``839'' and all that follows through ``(a)'' and inserting 
        ``839. (a)'';
            (6) in section 835(b), <<NOTE: 42 USC 297a.>> by striking 
        ``841'' each place it appears and inserting ``871'';
            (7) by redesignating section 841 <<NOTE: 42 USC 298d.>> as 
        section 871, moving part F to the end of the title, and 
        redesignating such part as part I;
            (8) in part G--
                    (A) by redesignating section 845 <<NOTE: 42 USC 
                297t.>>  as section 851; and
                    (B) by redesignating part G as part F;
            (9) in part H--
                    (A) by redesignating sections 851 and 852 <<NOTE: 42 
                USC 297w, 297x.>> as sections 861 and 862, respectively; 
                and
                    (B) by redesignating part H as part G; and
            (10) in part I--
                    (A) by redesignating section 855, <<NOTE: 42 USC 
                298.>>  as amended by section 5305, as section 865; and
                    (B) by redesignating part I as part H.

SEC. 5311. NURSE FACULTY LOAN PROGRAM.

    (a) In General.--Section 846A of the Public Health Service Act (42 
U.S.C. 297n-1) is amended--
            (1) in subsection (a)--
                    (A) in the subsection heading, by striking 
                ``Establishment'' and inserting ``School of Nursing 
                Student Loan Fund''; and
                    (B) by inserting ``accredited'' after ``agreement 
                with any'';
            (2) in subsection (c)--
                    (A) in paragraph (2), by striking ``$30,000'' and 
                all that follows through the semicolon and inserting 
                ``$35,500, during fiscal years 2010 and 2011 fiscal 
                years (after fiscal year 2011, such amounts shall be 
                adjusted to provide for

[[Page 124 STAT. 632]]

                a cost-of-attendance increase for the yearly loan rate 
                and the aggregate loan;''; and
                    (B) in paragraph (3)(A), by inserting ``an 
                accredited'' after ``faculty member in'';
            (3) in subsection (e), by striking ``a school'' and 
        inserting ``an accredited school''; and
            (4) in subsection (f), by striking ``2003 through 2007'' and 
        inserting ``2010 through 2014''.

    (b) Eligible Individual Student Loan Repayment.--Title VIII of the 
Public Health Service Act is amended by inserting after section 846A (42 
U.S.C. 297n-1) the following:

``SEC. 847. <<NOTE: 42 USC 297o.>> ELIGIBLE INDIVIDUAL STUDENT LOAN 
            REPAYMENT.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, may enter into an 
agreement with eligible individuals for the repayment of education 
loans, in accordance with this section, to increase the number of 
qualified nursing faculty.
    ``(b) Agreements.--Each agreement entered into under this subsection 
shall require that the eligible individual shall serve as a full-time 
member of the faculty of an accredited school of nursing, for a total 
period, in the aggregate, of at least 4 years during the 6-year period 
beginning on the later of--
            ``(1) the date on which the individual receives a master's 
        or doctorate nursing degree from an accredited school of 
        nursing; or
            ``(2) the date on which the individual enters into an 
        agreement under this subsection.

    ``(c) Agreement Provisions.--Agreements entered into pursuant to 
subsection (b) shall be entered into on such terms and conditions as the 
Secretary may determine, except that--
            ``(1) <<NOTE: Deadline.>> not more than 10 months after the 
        date on which the 6-year period described under subsection (b) 
        begins, but in no case before the individual starts as a full-
        time member of the faculty of an accredited school of nursing 
        the Secretary shall begin making payments, for and on behalf of 
        that individual, on the outstanding principal of, and interest 
        on, any loan of that individual obtained to pay for such degree;
            ``(2) for an individual who has completed a master's in 
        nursing or equivalent degree in nursing--
                    ``(A) payments may not exceed $10,000 per calendar 
                year; and
                    ``(B) total payments may not exceed $40,000 during 
                the 2010 and 2011 fiscal years (after fiscal year 2011, 
                such amounts shall be adjusted to provide for a cost-of-
                attendance increase for the yearly loan rate and the 
                aggregate loan); and
            ``(3) for an individual who has completed a doctorate or 
        equivalent degree in nursing--
                    ``(A) payments may not exceed $20,000 per calendar 
                year; and
                    ``(B) total payments may not exceed $80,000 during 
                the 2010 and 2011 fiscal years (adjusted for subsequent 
                fiscal years as provided for in the same manner as in 
                paragraph (2)(B)).

    ``(d) Breach of Agreement.--

[[Page 124 STAT. 633]]

            ``(1) In general.--In the case of any agreement made under 
        subsection (b), the individual is liable to the Federal 
        Government for the total amount paid by the Secretary under such 
        agreement, and for interest on such amount at the maximum legal 
        prevailing rate, if the individual fails to meet the agreement 
        terms required under such subsection.
            ``(2) Waiver or suspension of liability.--In the case of an 
        individual making an agreement for purposes of paragraph (1), 
        the Secretary shall provide for the waiver or suspension of 
        liability under such paragraph if compliance by the individual 
        with the agreement involved is impossible or would involve 
        extreme hardship to the individual or if enforcement of the 
        agreement with respect to the individual would be 
        unconscionable.
            ``(3) Date certain for recovery.--Subject to paragraph (2), 
        any amount that the Federal Government is entitled to recover 
        under paragraph (1) shall be paid to the United States not later 
        than the expiration of the 3-year period beginning on the date 
        the United States becomes so entitled.
            ``(4) Availability.--Amounts recovered under paragraph (1) 
        shall be available to the Secretary for making loan repayments 
        under this section and shall remain available for such purpose 
        until expended.

    ``(e) Eligible Individual Defined.--For purposes of this section, 
the term `eligible individual' means an individual who--
            ``(1) is a United States citizen, national, or lawful 
        permanent resident;
            ``(2) holds an unencumbered license as a registered nurse; 
        and
            ``(3) has either already completed a master's or doctorate 
        nursing program at an accredited school of nursing or is 
        currently enrolled on a full-time or part-time basis in such a 
        program.

    ``(f) Priority.--For the purposes of this section and section 846A, 
funding priority will be awarded to School of Nursing Student Loans that 
support doctoral nursing students or Individual Student Loan Repayment 
that support doctoral nursing students.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary for 
each of fiscal years 2010 through 2014.''.

SEC. 5312. AUTHORIZATION OF APPROPRIATIONS FOR PARTS B THROUGH D OF 
            TITLE VIII.

    Section 871 of the Public Health Service Act, as redesignated and 
moved by section 5310, is amended to read as follows:

``SEC. 871. <<NOTE: 42 USC 298d.>> AUTHORIZATION OF APPROPRIATIONS.

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

SEC. 5313. GRANTS TO PROMOTE THE COMMUNITY HEALTH WORKFORCE.

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

[[Page 124 STAT. 634]]

``SEC. 399V. <<NOTE: 42 USC 280g-11.>> GRANTS TO PROMOTE POSITIVE HEALTH 
            BEHAVIORS AND OUTCOMES.

    ``(a) Grants Authorized.--The Director of the Centers for Disease 
Control and Prevention, in collaboration with the Secretary, shall award 
grants to eligible entities to promote positive health behaviors and 
outcomes for populations in medically underserved communities through 
the use of community health workers.
    ``(b) Use of Funds.--Grants awarded under subsection (a) shall be 
used to support community health workers--
            ``(1) to educate, guide, and provide outreach in a community 
        setting regarding health problems prevalent in medically 
        underserved communities, particularly racial and ethnic minority 
        populations;
            ``(2) to educate and provide guidance regarding effective 
        strategies to promote positive health behaviors and discourage 
        risky health behaviors;
            ``(3) to educate and provide outreach regarding enrollment 
        in health insurance including the Children's Health Insurance 
        Program under title XXI of the Social Security Act, Medicare 
        under title XVIII of such Act and Medicaid under title XIX of 
        such Act;
            ``(4) to identify, educate, refer, and enroll underserved 
        populations to appropriate healthcare agencies and community-
        based programs and organizations in order to increase access to 
        quality healthcare services and to eliminate duplicative care; 
        or
            ``(5) to educate, guide, and provide home visitation 
        services regarding maternal health and prenatal care.

    ``(c) Application.--Each eligible entity that desires to receive a 
grant under subsection (a) shall submit an application to the Secretary, 
at such time, in such manner, and accompanied by such information as the 
Secretary may require.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to applicants that--
            ``(1) propose to target geographic areas--
                    ``(A) with a high percentage of residents who are 
                eligible for health insurance but are uninsured or 
                underinsured;
                    ``(B) with a high percentage of residents who suffer 
                from chronic diseases; or
                    ``(C) with a high infant mortality rate;
            ``(2) have experience in providing health or health-related 
        social services to individuals who are underserved with respect 
        to such services; and
            ``(3) have documented community activity and experience with 
        community health workers.

    ``(e) Collaboration With Academic Institutions and the One-stop 
Delivery System.--The Secretary shall encourage community health worker 
programs receiving funds under this section to collaborate with academic 
institutions and one-stop delivery systems under section 134(c) of the 
Workforce Investment Act of 1998. Nothing in this section shall be 
construed to require such collaboration.
    ``(f) Evidence-based Interventions.--The Secretary shall encourage 
community health worker programs receiving funding under this section to 
implement a process or an outcome-based

[[Page 124 STAT. 635]]

payment system that rewards community health workers for connecting 
underserved populations with the most appropriate services at the most 
appropriate time. Nothing in this section shall be construed to require 
such a payment.
    ``(g) Quality Assurance and Cost 
Effectiveness. <<NOTE: Guidelines.>> --The Secretary shall establish 
guidelines for assuring the quality of the training and supervision of 
community health workers under the programs funded under this section 
and for assuring the cost-effectiveness of such programs.

    ``(h) Monitoring.--The Secretary shall monitor community health 
worker programs identified in approved applications under this section 
and shall determine whether such programs are in compliance with the 
guidelines established under subsection (g).
    ``(i) Technical Assistance.--The Secretary may provide technical 
assistance to community health worker programs identified in approved 
applications under this section with respect to planning, developing, 
and operating programs under the grant.
    ``(j) Authorization of Appropriations.--There are authorized to be 
appropriated, such sums as may be necessary to carry out this section 
for each of fiscal years 2010 through 2014.
    ``(k) Definitions.--In this section:
            ``(1) Community health worker.--The term `community health 
        worker', as defined by the Department of Labor as Standard 
        Occupational Classification [21-1094] means an individual who 
        promotes health or nutrition within the community in which the 
        individual resides--
                    ``(A) by serving as a liaison between communities 
                and healthcare agencies;
                    ``(B) by providing guidance and social assistance to 
                community residents;
                    ``(C) by enhancing community residents' ability to 
                effectively communicate with healthcare providers;
                    ``(D) by providing culturally and linguistically 
                appropriate health or nutrition education;
                    ``(E) by advocating for individual and community 
                health;
                    ``(F) by providing referral and follow-up services 
                or otherwise coordinating care; and
                    ``(G) by proactively identifying and enrolling 
                eligible individuals in Federal, State, local, private 
                or nonprofit health and human services programs.
            ``(2) Community setting.--The term `community setting' means 
        a home or a community organization located in the neighborhood 
        in which a participant in the program under this section 
        resides.
            ``(3) Eligible entity.--The term `eligible entity' means a 
        public or nonprofit private entity (including a State or public 
        subdivision of a State, a public health department, a free 
        health clinic, a hospital, or a Federally-qualified health 
        center (as defined in section 1861(aa) of the Social Security 
        Act)), or a consortium of any such entities.
            ``(4) Medically underserved community.--The term `medically 
        underserved community' means a community identified by a State--
                    ``(A) that has a substantial number of individuals 
                who are members of a medically underserved population, 
                as defined by section 330(b)(3); and

[[Page 124 STAT. 636]]

                    ``(B) a significant portion of which is a health 
                professional shortage area as designated under section 
                332.''.

SEC. 5314. FELLOWSHIP TRAINING IN PUBLIC HEALTH.

    Part E of title VII of the Public Health Service Act (42 U.S.C. 294n 
et seq.), as amended by section 5206, is further amended by adding at 
the end the following:

``SEC. 778. <<NOTE: 42 USC 295f-3.>> FELLOWSHIP TRAINING IN APPLIED 
            PUBLIC HEALTH EPIDEMIOLOGY, PUBLIC HEALTH LABORATORY 
            SCIENCE, PUBLIC HEALTH INFORMATICS, AND EXPANSION OF THE 
            EPIDEMIC INTELLIGENCE SERVICE.

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

SEC. 5315. UNITED STATES PUBLIC HEALTH SCIENCES TRACK.

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

[[Page 124 STAT. 637]]

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

``SEC. 271. <<NOTE: 42 USC 239l.>> ESTABLISHMENT.

    ``(a) United States Public Health Services Track.--
            ``(1) In general.--There is hereby authorized to be 
        established a United States Public Health Sciences Track 
        (referred to in this part as the `Track'), at sites to be 
        selected by the Secretary, with authority to grant appropriate 
        advanced degrees in a manner that uniquely emphasizes team-based 
        service, public health, epidemiology, and emergency preparedness 
        and response. It shall be so organized as to graduate not less 
        than--
                    ``(A) 150 medical students annually, 10 of whom 
                shall be awarded studentships to the Uniformed Services 
                University of Health Sciences;
                    ``(B) 100 dental students annually;
                    ``(C) 250 nursing students annually;
                    ``(D) 100 public health students annually;
                    ``(E) 100 behavioral and mental health professional 
                students annually;
                    ``(F) 100 physician assistant or nurse practitioner 
                students annually; and
                    ``(G) 50 pharmacy students annually.
            ``(2) Locations.--The Track shall be located at existing and 
        accredited, affiliated health professions education training 
        programs at academic health centers located in regions of the 
        United States determined appropriate by the Surgeon General, in 
        consultation with the National Health Care Workforce Commission 
        established in section 5101 of the Patient Protection and 
        Affordable Care Act.

    ``(b) Number of Graduates.--Except as provided in subsection (a), 
the number of persons to be graduated from the Track shall be prescribed 
by the Secretary. In so prescribing the number of persons to be 
graduated from the Track, the Secretary shall institute actions 
necessary to ensure the maximum number of first-year enrollments in the 
Track consistent with the academic capacity of the affiliated sites and 
the needs of the United States for medical, dental, and nursing 
personnel.
    ``(c) Development.--The development of the Track may be by such 
phases as the Secretary may prescribe subject to the requirements of 
subsection (a).
    ``(d) Integrated Longitudinal Plan.--The Surgeon General shall 
develop an integrated longitudinal plan for health professions 
continuing education throughout the continuum of health-related 
education, training, and practice. Training under such plan shall 
emphasize patient-centered, interdisciplinary, and care coordination 
skills. Experience with deployment of emergency response teams shall be 
included during the clinical experiences.
    ``(e) Faculty Development.--The Surgeon General shall develop 
faculty development programs and curricula in decentralized venues of 
health care, to balance urban, tertiary, and inpatient venues.

``SEC. 272. <<NOTE: 42 USC 239l-1.>> ADMINISTRATION.

    ``(a) In General.--The business of the Track shall be conducted by 
the Surgeon General with funds appropriated for and provided

[[Page 124 STAT. 638]]

by the Department of Health and Human Services. The National Health Care 
Workforce Commission shall assist the Surgeon General in an advisory 
capacity.
    ``(b) Faculty.--
            ``(1) In general.--The Surgeon General, after considering 
        the recommendations of the National Health Care Workforce 
        Commission, shall obtain the services of such professors, 
        instructors, and administrative and other employees as may be 
        necessary to operate the Track, but utilize when possible, 
        existing affiliated health professions training institutions. 
        Members of the faculty and staff shall be employed under salary 
        schedules and granted retirement and other related benefits 
        prescribed by the Secretary so as to place the employees of the 
        Track faculty on a comparable basis with the employees of fully 
        accredited schools of the health professions within the United 
        States.
            ``(2) Titles.--The Surgeon General may confer academic 
        titles, as appropriate, upon the members of the faculty.
            ``(3) Nonapplication of provisions.--The limitations in 
        section 5373 of title 5, United States Code, shall not apply to 
        the authority of the Surgeon General under paragraph (1) to 
        prescribe salary schedules and other related benefits.

    ``(c) Agreements.--The Surgeon General may negotiate agreements with 
agencies of the Federal Government to utilize on a reimbursable basis 
appropriate existing Federal medical resources located in the United 
States (or locations selected in accordance with section 271(a)(2)). 
Under such agreements the facilities concerned will retain their 
identities and basic missions. The Surgeon General may negotiate 
affiliation agreements with accredited universities and health 
professions training institutions in the United States. Such agreements 
may include provisions for payments for educational services provided 
students participating in Department of Health and Human Services 
educational programs.
    ``(d) Programs.--The Surgeon General may establish the following 
educational programs for Track students:
            ``(1) Postdoctoral, postgraduate, and technological 
        programs.
            ``(2) A cooperative program for medical, dental, physician 
        assistant, pharmacy, behavioral and mental health, public 
        health, and nursing students.
            ``(3) Other programs that the Surgeon General determines 
        necessary in order to operate the Track in a cost-effective 
        manner.

    ``(e) Continuing Medical Education.--The Surgeon General shall 
establish programs in continuing medical education for members of the 
health professions to the end that high standards of health care may be 
maintained within the United States.
    ``(f) Authority of the Surgeon General.--
            ``(1) <<NOTE: Contracts. Grants.>> In general.--The Surgeon 
        General is authorized--
                    ``(A) to enter into contracts with, accept grants 
                from, and make grants to any nonprofit entity for the 
                purpose of carrying out cooperative enterprises in 
                medical, dental, physician assistant, pharmacy, 
                behavioral and mental health, public health, and nursing 
                research, consultation, and education;
                    ``(B) to enter into contracts with entities under 
                which the Surgeon General may furnish the services of 
                such

[[Page 124 STAT. 639]]

                professional, technical, or clerical personnel as may be 
                necessary to fulfill cooperative enterprises undertaken 
                by the Track;
                    ``(C) to accept, hold, administer, invest, and spend 
                any gift, devise, or bequest of personal property made 
                to the Track, including any gift, devise, or bequest for 
                the support of an academic chair, teaching, research, or 
                demonstration project;
                    ``(D) to enter into agreements with entities that 
                may be utilized by the Track for the purpose of 
                enhancing the activities of the Track in education, 
                research, and technological applications of knowledge; 
                and
                    ``(E) to accept the voluntary services of guest 
                scholars and other persons.
            ``(2) Limitation.--The Surgeon General may not enter into 
        any contract with an entity if the contract would obligate the 
        Track to make outlays in advance of the enactment of budget 
        authority for such outlays.
            ``(3) Scientists.--Scientists or other medical, dental, or 
        nursing personnel utilized by the Track under an agreement 
        described in paragraph (1) may be appointed to any position 
        within the Track and may be permitted to perform such duties 
        within the Track as the Surgeon General may approve.
            ``(4) Volunteer services.--A person who provides voluntary 
        services under the authority of subparagraph (E) of paragraph 
        (1) shall be considered to be an employee of the Federal 
        Government for the purposes of chapter 81 of title 5, relating 
        to compensation for work-related injuries, and to be an employee 
        of the Federal Government for the purposes of chapter 171 of 
        title 28, relating to tort claims. Such a person who is not 
        otherwise employed by the Federal Government shall not be 
        considered to be a Federal employee for any other purpose by 
        reason of the provision of such services.

``SEC. 273. <<NOTE: 42 USC 239l-2.>> STUDENTS; SELECTION; OBLIGATION.

    ``(a) Student Selection.--
            ``(1) In general.--Medical, dental, physician assistant, 
        pharmacy, behavioral and mental health, public health, and 
        nursing students at the Track shall be selected under procedures 
        prescribed by the Surgeon General. In so prescribing, the 
        Surgeon General shall consider the recommendations of the 
        National Health Care Workforce Commission.
            ``(2) Priority.--In developing admissions procedures under 
        paragraph (1), the Surgeon General shall ensure that such 
        procedures give priority to applicant medical, dental, physician 
        assistant, pharmacy, behavioral and mental health, public 
        health, and nursing students from rural communities and 
        underrepresented minorities.

    ``(b) Contract and Service Obligation.--
            ``(1) Contract.--Upon being admitted to the Track, a 
        medical, dental, physician assistant, pharmacy, behavioral and 
        mental health, public health, or nursing student shall enter 
        into a written contract with the Surgeon General that shall 
        contain--
                    ``(A) an agreement under which--
                          ``(i) subject to subparagraph (B), the Surgeon 
                      General agrees to provide the student with tuition 
                      (or

[[Page 124 STAT. 640]]

                      tuition remission) and a student stipend 
                      (described in paragraph (2)) in each school year 
                      for a period of years (not to exceed 4 school 
                      years) determined by the student, during which 
                      period the student is enrolled in the Track at an 
                      affiliated or other participating health 
                      professions institution pursuant to an agreement 
                      between the Track and such institution; and
                          ``(ii) subject to subparagraph (B), the 
                      student agrees--
                                    ``(I) to accept the provision of 
                                such tuition and student stipend to the 
                                student;
                                    ``(II) to maintain enrollment at the 
                                Track until the student completes the 
                                course of study involved;
                                    ``(III) while enrolled in such 
                                course of study, to maintain an 
                                acceptable level of academic standing 
                                (as determined by the Surgeon General);
                                    ``(IV) if pursuing a degree from a 
                                school of medicine or osteopathic 
                                medicine, dental, public health, or 
                                nursing school or a physician assistant, 
                                pharmacy, or behavioral and mental 
                                health professional program, to complete 
                                a residency or internship in a specialty 
                                that the Surgeon General determines is 
                                appropriate; and
                                    ``(V) to serve for a period of time 
                                (referred to in this part as the `period 
                                of obligated service') within the 
                                Commissioned Corps of the Public Health 
                                Service equal to 2 years for each school 
                                year during which such individual was 
                                enrolled at the College, reduced as 
                                provided for in paragraph (3);
                    ``(B) a provision that any financial obligation of 
                the United States arising out of a contract entered into 
                under this part and any obligation of the student which 
                is conditioned thereon, is contingent upon funds being 
                appropriated to carry out this part;
                    ``(C) a statement of the damages to which the United 
                States is entitled for the student's breach of the 
                contract; and
                    ``(D) such other statements of the rights and 
                liabilities of the Secretary and of the individual, not 
                inconsistent with the provisions of this part.
            ``(2) Tuition and student stipend.--
                    ``(A) Tuition remission rates.--The Surgeon General, 
                based on the recommendations of the National Health Care 
                Workforce Commission, shall establish Federal tuition 
                remission rates to be used by the Track to provide 
                reimbursement to affiliated and other participating 
                health professions institutions for the cost of 
                educational services provided by such institutions to 
                Track students. The agreement entered into by such 
                participating institutions under paragraph (1)(A)(i) 
                shall contain an agreement to accept as payment in full 
                the established remission rate under this subparagraph.
                    ``(B) Stipend.--The Surgeon General, based on the 
                recommendations of the National Health Care Workforce

[[Page 124 STAT. 641]]

                Commission, shall establish and update Federal stipend 
                rates for payment to students under this part.
            ``(3) Reductions in the period of obligated service.--The 
        period of obligated service under paragraph (1)(A)(ii)(V) shall 
        be reduced--
                    ``(A) in the case of a student who elects to 
                participate in a high-needs speciality residency (as 
                determined by the National Health Care Workforce 
                Commission), by 3 months for each year of such 
                participation (not to exceed a total of 12 months); and
                    ``(B) in the case of a student who, upon completion 
                of their residency, elects to practice in a Federal 
                medical facility (as defined in section 781(e)) that is 
                located in a health professional shortage area (as 
                defined in section 332), by 3 months for year of full-
                time practice in such a facility (not to exceed a total 
                of 12 months).

    ``(c) Second 2 Years of Service.--During the third and fourth years 
in which a medical, dental, physician assistant, pharmacy, behavioral 
and mental health, public health, or nursing student is enrolled in the 
Track, training should be designed to prioritize clinical rotations in 
Federal medical facilities in health professional shortage areas, and 
emphasize a balance of hospital and community-based experiences, and 
training within interdisciplinary teams.
    ``(d) Dentist, Physician Assistant, Pharmacist, Behavioral and 
Mental Health Professional, Public Health Professional, and Nurse 
Training.--The Surgeon General shall establish provisions applicable 
with respect to dental, physician assistant, pharmacy, behavioral and 
mental health, public health, and nursing students that are comparable 
to those for medical students under this section, including service 
obligations, tuition support, and stipend support. The Surgeon General 
shall give priority to health professions training institutions that 
train medical, dental, physician assistant, pharmacy, behavioral and 
mental health, public health, and nursing students for some significant 
period of time together, but at a minimum have a discrete and shared 
core curriculum.
    ``(e) <<NOTE: Criteria.>> Elite Federal Disaster Teams.--The Surgeon 
General, in consultation with the Secretary, the Director of the Centers 
for Disease Control and Prevention, and other appropriate military and 
Federal government agencies, shall develop criteria for the appointment 
of highly qualified Track faculty, medical, dental, physician assistant, 
pharmacy, behavioral and mental health, public health, and nursing 
students, and graduates to elite Federal disaster preparedness teams to 
train and to respond to public health emergencies, natural disasters, 
bioterrorism events, and other emergencies.

    ``(f) <<NOTE: Regulations.>> Student Dropped From Track in Affiliate 
School.--A medical, dental, physician assistant, pharmacy, behavioral 
and mental health, public health, or nursing student who, under 
regulations prescribed by the Surgeon General, is dropped from the Track 
in an affiliated school for deficiency in conduct or studies, or for 
other reasons, shall be liable to the United States for all tuition and 
stipend support provided to the student.

[[Page 124 STAT. 642]]

``SEC. 274. <<NOTE: 42 USC 239l-3.>> FUNDING.

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

        Subtitle E--Supporting the Existing Health Care Workforce

SEC. 5401. CENTERS OF EXCELLENCE.

    Section 736 of the Public Health Service Act (42 U.S.C. 293) is 
amended by striking subsection (h) and inserting the following:
    ``(h) <<NOTE: Grants.>> Formula for Allocations.--
            ``(1) <<NOTE: Applicability.>> Allocations.--Based on the 
        amount appropriated under subsection (i) for a fiscal year, the 
        following subparagraphs shall apply as appropriate:
                    ``(A) In general.--If the amounts appropriated under 
                subsection (i) for a fiscal year are $24,000,000 or 
                less--
                          ``(i) the Secretary shall make available 
                      $12,000,000 for grants under subsection (a) to 
                      health professions schools that meet the 
                      conditions described in subsection (c)(2)(A); and
                          ``(ii) and available after grants are made 
                      with funds under clause (i), the Secretary shall 
                      make available--
                                    ``(I) 60 percent of such amount for 
                                grants under subsection (a) to health 
                                professions schools that meet the 
                                conditions described in paragraph (3) or 
                                (4) of subsection (c) (including meeting 
                                the conditions under subsection (e)); 
                                and
                                    ``(II) 40 percent of such amount for 
                                grants under subsection (a) to health 
                                professions schools that meet the 
                                conditions described in subsection 
                                (c)(5).
                    ``(B) Funding in excess of $24,000,000.--If amounts 
                appropriated under subsection (i) for a fiscal year 
                exceed $24,000,000 but are less than $30,000,000--
                          ``(i) 80 percent of such excess amounts shall 
                      be made available for grants under subsection (a) 
                      to health professions schools that meet the 
                      requirements described in paragraph (3) or (4) of 
                      subsection (c) (including meeting conditions 
                      pursuant to subsection (e)); and
                          ``(ii) 20 percent of such excess amount shall 
                      be made available for grants under subsection (a) 
                      to health professions schools that meet the 
                      conditions described in subsection (c)(5).
                    ``(C) Funding in excess of $30,000,000.--If amounts 
                appropriated under subsection (i) for a fiscal year 
                exceed $30,000,000 but are less than $40,000,000, the 
                Secretary shall make available--
                          ``(i) not less than $12,000,000 for grants 
                      under subsection (a) to health professions schools 
                      that meet the conditions described in subsection 
                      (c)(2)(A);
                          ``(ii) not less than $12,000,000 for grants 
                      under subsection (a) to health professions schools 
                      that meet the conditions described in paragraph 
                      (3) or (4) of

[[Page 124 STAT. 643]]

                      subsection (c) (including meeting conditions 
                      pursuant to subsection (e));
                          ``(iii) not less than $6,000,000 for grants 
                      under subsection (a) to health professions schools 
                      that meet the conditions described in subsection 
                      (c)(5); and
                          ``(iv) after grants are made with funds under 
                      clauses (i) through (iii), any remaining excess 
                      amount for grants under subsection (a) to health 
                      professions schools that meet the conditions 
                      described in paragraph (2)(A), (3), (4), or (5) of 
                      subsection (c).
                    ``(D) Funding in excess of $40,000,000.--If amounts 
                appropriated under subsection (i) for a fiscal year are 
                $40,000,000 or more, the Secretary shall make 
                available--
                          ``(i) not less than $16,000,000 for grants 
                      under subsection (a) to health professions schools 
                      that meet the conditions described in subsection 
                      (c)(2)(A);
                          ``(ii) not less than $16,000,000 for grants 
                      under subsection (a) to health professions schools 
                      that meet the conditions described in paragraph 
                      (3) or (4) of subsection (c) (including meeting 
                      conditions pursuant to subsection (e));
                          ``(iii) not less than $8,000,000 for grants 
                      under subsection (a) to health professions schools 
                      that meet the conditions described in subsection 
                      (c)(5); and
                          ``(iv) after grants are made with funds under 
                      clauses (i) through (iii), any remaining funds for 
                      grants under subsection (a) to health professions 
                      schools that meet the conditions described in 
                      paragraph (2)(A), (3), (4), or (5) of subsection 
                      (c).
            ``(2) No limitation.--Nothing in this subsection shall be 
        construed as limiting the centers of excellence referred to in 
        this section to the designated amount, or to preclude such 
        entities from competing for grants under this section.
            ``(3) Maintenance of effort.--
                    ``(A) In general.--With respect to activities for 
                which a grant made under this part are authorized to be 
                expended, the Secretary may not make such a grant to a 
                center of excellence for any fiscal year unless the 
                center agrees to maintain expenditures of non-Federal 
                amounts for such activities at a level that is not less 
                than the level of such expenditures maintained by the 
                center for the fiscal year preceding the fiscal year for 
                which the school receives such a grant.
                    ``(B) Use of federal funds.--With respect to any 
                Federal amounts received by a center of excellence and 
                available for carrying out activities for which a grant 
                under this part is authorized to be expended, the center 
                shall, before expending the grant, expend the Federal 
                amounts obtained from sources other than the grant, 
                unless given prior approval from the Secretary.

    ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section--
            ``(1) $50,000,000 for each of the fiscal years 2010 through 
        2015; and
            ``(2) and such sums as are necessary for each subsequent 
        fiscal year.''.

[[Page 124 STAT. 644]]

SEC. 5402. HEALTH CARE PROFESSIONALS TRAINING FOR DIVERSITY.

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

SEC. 5403. INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES.

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

``SEC. 751. AREA HEALTH EDUCATION CENTERS.

    ``(a) Establishment of Awards.--The Secretary shall make the 
following 2 types of awards in accordance with this section:
            ``(1) Infrastructure development award.--The Secretary shall 
        make awards to eligible entities to enable such entities to 
        initiate health care workforce educational programs or to 
        continue to carry out comparable programs that are operating at 
        the time the award is made by planning, developing, operating, 
        and evaluating an area health education center program.
            ``(2) Point of service maintenance and enhancement award.--
        The Secretary shall make awards to eligible entities to maintain 
        and improve the effectiveness and capabilities of an existing 
        area health education center program, and make other 
        modifications to the program that are appropriate due to changes 
        in demographics, needs of the populations served, or other 
        similar issues affecting the area health education center 
        program. For the purposes of this section, the term `Program' 
        refers to the area health education center program.

    ``(b) Eligible Entities; Application.--
            ``(1) <<NOTE: Definitions.>> Eligible entities.--
                    ``(A) Infrastructure development.--For purposes of 
                subsection (a)(1), the term `eligible entity' means a 
                school of medicine or osteopathic medicine, an 
                incorporated consortium of such schools, or the parent 
                institutions of such a school. With respect to a State 
                in which no area

[[Page 124 STAT. 645]]

                health education center program is in operation, the 
                Secretary may award a grant or contract under subsection 
                (a)(1) to a school of nursing.
                    ``(B) Point of service maintenance and 
                enhancement.--For purposes of subsection (a)(2), the 
                term `eligible entity' means an entity that has received 
                funds under this section, is operating an area health 
                education center program, including an area health 
                education center or centers, and has a center or centers 
                that are no longer eligible to receive financial 
                assistance under subsection (a)(1).
            ``(2) Application.--An eligible entity desiring to receive 
        an award under this section shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require.

    ``(c) Use of Funds.--
            ``(1) Required activities. <<NOTE: Grants.>> --An eligible 
        entity shall use amounts awarded under a grant under subsection 
        (a)(1) or (a)(2) to carry out the following activities:
                    ``(A) Develop and implement strategies, in 
                coordination with the applicable one-stop delivery 
                system under section 134(c) of the Workforce Investment 
                Act of 1998, to recruit individuals from 
                underrepresented minority populations or from 
                disadvantaged or rural backgrounds into health 
                professions, and support such individuals in attaining 
                such careers.
                    ``(B) Develop and implement strategies to foster and 
                provide community-based training and education to 
                individuals seeking careers in health professions within 
                underserved areas for the purpose of developing and 
                maintaining a diverse health care workforce that is 
                prepared to deliver high-quality care, with an emphasis 
                on primary care, in underserved areas or for health 
                disparity populations, in collaboration with other 
                Federal and State health care workforce development 
                programs, the State workforce agency, and local 
                workforce investment boards, and in health care safety 
                net sites.
                    ``(C) Prepare individuals to more effectively 
                provide health services to underserved areas and health 
                disparity populations through field placements or 
                preceptorships in conjunction with community-based 
                organizations, accredited primary care residency 
                training programs, Federally qualified health centers, 
                rural health clinics, public health departments, or 
                other appropriate facilities.
                    ``(D) Conduct and participate in interdisciplinary 
                training that involves physicians, physician assistants, 
                nurse practitioners, nurse midwives, dentists, 
                psychologists, pharmacists, optometrists, community 
                health workers, public and allied health professionals, 
                or other health professionals, as practicable.
                    ``(E) Deliver or facilitate continuing education and 
                information dissemination programs for health care 
                professionals, with an emphasis on individuals providing 
                care in underserved areas and for health disparity 
                populations.
                    ``(F) Propose and implement effective program and 
                outcomes measurement and evaluation strategies.

[[Page 124 STAT. 646]]

                    ``(G) Establish a youth public health program to 
                expose and recruit high school students into health 
                careers, with a focus on careers in public health.
            ``(2) Innovative opportunities.--An eligible entity may use 
        amounts awarded under a grant under subsection (a)(1) or 
        subsection (a)(2) to carry out any of the following activities:
                    ``(A) Develop and implement innovative curricula in 
                collaboration with community-based accredited primary 
                care residency training programs, Federally qualified 
                health centers, rural health clinics, behavioral and 
                mental health facilities, public health departments, or 
                other appropriate facilities, with the goal of 
                increasing the number of primary care physicians and 
                other primary care providers prepared to serve in 
                underserved areas and health disparity populations.
                    ``(B) Coordinate community-based participatory 
                research with academic health centers, and facilitate 
                rapid flow and dissemination of evidence-based health 
                care information, research results, and best practices 
                to improve quality, efficiency, and effectiveness of 
                health care and health care systems within community 
                settings.
                    ``(C) Develop and implement other strategies to 
                address identified workforce needs and increase and 
                enhance the health care workforce in the area served by 
                the area health education center program.

    ``(d) Requirements.--
            ``(1) Area health education center program.--In carrying out 
        this section, the Secretary shall ensure the following:
                    ``(A) An entity that receives an award under this 
                section shall conduct at least 10 percent of clinical 
                education required for medical students in community 
                settings that are removed from the primary teaching 
                facility of the contracting institution for grantees 
                that operate a school of medicine or osteopathic 
                medicine. In States in which an entity that receives an 
                award under this section is a nursing school or its 
                parent institution, the Secretary shall alternatively 
                ensure that--
                          ``(i) the nursing school conducts at least 10 
                      percent of clinical education required for nursing 
                      students in community settings that are remote 
                      from the primary teaching facility of the school; 
                      and
                          ``(ii) the entity receiving the award 
                      maintains a written agreement with a school of 
                      medicine or osteopathic medicine to place students 
                      from that school in training sites in the area 
                      health education center program area.
                    ``(B) An entity receiving funds under subsection 
                (a)(2) does not distribute such funding to a center that 
                is eligible to receive funding under subsection (a)(1).
            ``(2) Area health education center.--The Secretary shall 
        ensure that each area health education center program includes 
        at least 1 area health education center, and that each such 
        center--
                    ``(A) is a public or private organization whose 
                structure, governance, and operation is independent from 
                the awardee and the parent institution of the awardee;

[[Page 124 STAT. 647]]

                    ``(B) is not a school of medicine or osteopathic 
                medicine, the parent institution of such a school, or a 
                branch campus or other subunit of a school of medicine 
                or osteopathic medicine or its parent institution, or a 
                consortium of such entities;
                    ``(C) designates an underserved area or population 
                to be served by the center which is in a location 
                removed from the main location of the teaching 
                facilities of the schools participating in the program 
                with such center and does not duplicate, in whole or in 
                part, the geographic area or population served by any 
                other center;
                    ``(D) fosters networking and collaboration among 
                communities and between academic health centers and 
                community-based centers;
                    ``(E) serves communities with a demonstrated need of 
                health professionals in partnership with academic 
                medical centers;
                    ``(F) addresses the health care workforce needs of 
                the communities served in coordination with the public 
                workforce investment system; and
                    ``(G) has a community-based governing or advisory 
                board that reflects the diversity of the communities 
                involved.

    ``(e) Matching Funds.--With respect to the costs of operating a 
program through a grant under this section, to be eligible for financial 
assistance under this section, an entity shall make available (directly 
or through contributions from State, county or municipal governments, or 
the private sector) recurring non-Federal contributions in cash or in 
kind, toward such costs in an amount that is equal to not less than 50 
percent of such costs. At least 25 percent of the total required non-
Federal contributions shall be in cash. An entity may apply to the 
Secretary for a waiver of not more than 75 percent of the matching fund 
amount required by the entity for each of the first 3 years the entity 
is funded through a grant under subsection (a)(1).
    ``(f) Limitation.--Not less than 75 percent of the total amount 
provided to an area health education center program under subsection 
(a)(1) or (a)(2) shall be allocated to the area health education centers 
participating in the program under this section. <<NOTE: Waiver 
authority.>>  To provide needed flexibility to newly funded area health 
education center programs, the Secretary may waive the requirement in 
the sentence for the first 2 years of a new area health education center 
program funded under subsection (a)(1).

    ``(g) Award.--An award to an entity under this section shall be not 
less than $250,000 annually per area health education center included in 
the program involved. If amounts appropriated to carry out this section 
are not sufficient to comply with the preceding sentence, the Secretary 
may reduce the per center amount provided for in such sentence as 
necessary, provided the distribution established in subsection (j)(2) is 
maintained.
    ``(h) Project Terms.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        period during which payments may be made under an award under 
        subsection (a)(1) may not exceed--
                    ``(A) in the case of a program, 12 years; or
                    ``(B) in the case of a center within a program, 6 
                years.

[[Page 124 STAT. 648]]

            ``(2) Exception.--The periods described in paragraph (1) 
        shall not apply to programs receiving point of service 
        maintenance and enhancement awards under subsection (a)(2) to 
        maintain existing centers and activities.

    ``(i) Inapplicability of Provision.--Notwithstanding any other 
provision of this title, section 791(a) shall not apply to an area 
health education center funded under this section.
    ``(j) Authorization of Appropriations.--
            ``(1) In general.--There is authorized to be appropriated to 
        carry out this section $125,000,000 for each of the fiscal years 
        2010 through 2014.
            ``(2) Requirements.--Of the amounts appropriated for a 
        fiscal year under paragraph (1)--
                    ``(A) not more than 35 percent shall be used for 
                awards under subsection (a)(1);
                    ``(B) not less than 60 percent shall be used for 
                awards under subsection (a)(2);
                    ``(C) not more than 1 percent shall be used for 
                grants and contracts to implement outcomes evaluation 
                for the area health education centers; and
                    ``(D) not more than 4 percent shall be used for 
                grants and contracts to provide technical assistance to 
                entities receiving awards under this section.
            ``(3) Carryover funds.--An entity that receives an award 
        under this section may carry over funds from 1 fiscal year to 
        another without obtaining approval from the Secretary. In no 
        case may any funds be carried over pursuant to the preceding 
        sentence for more than 3 years.

    ``(k) Sense of Congress.--It is the sense of the Congress that every 
State have an area health education center program in effect under this 
section.''.
    (b) Continuing Educational Support for Health Professionals Serving 
in Underserved Communities.--Part D of title VII of the Public Health 
Service Act (42 U.S.C. 294 et seq.) is amended by striking section 
752 <<NOTE: 42 USC 294b.>> and inserting the following:

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

    ``(a) In General. <<NOTE: Grants. Contracts.>> --The Secretary shall 
make grants to, and enter into contracts with, eligible entities to 
improve health care, increase retention, increase representation of 
minority faculty members, enhance the practice environment, and provide 
information dissemination and educational support to reduce professional 
isolation through the timely dissemination of research findings using 
relevant resources.

    ``(b) Eligible Entities. <<NOTE: Definition.>> --For purposes of 
this section, the term `eligible entity' means an entity described in 
section 799(b).

    ``(c) Application.--An eligible entity desiring to receive an award 
under this section shall submit to the Secretary an application at such 
time, in such manner, and containing such information as the Secretary 
may require.
    ``(d) Use of Funds.--An eligible entity shall use amounts awarded 
under a grant or contract under this section to provide

[[Page 124 STAT. 649]]

innovative supportive activities to enhance education through distance 
learning, continuing educational activities, collaborative conferences, 
and electronic and telelearning activities, with priority for primary 
care.
    ``(e) Authorization.--There is authorized to be appropriated to 
carry out this section $5,000,000 for each of the fiscal years 2010 
through 2014, and such sums as may be necessary for each subsequent 
fiscal year.''.

SEC. 5404. WORKFORCE DIVERSITY GRANTS.

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

SEC. 5405. PRIMARY CARE EXTENSION PROGRAM.

    Part P of title III of the Public Health Service Act (42 U.S.C. 280g 
et seq.), as amended by section 5313, is further amended by adding at 
the end the following:

``SEC. 399W. <<NOTE: 42 USC 280g-12.>> PRIMARY CARE EXTENSION PROGRAM.

    ``(a) Establishment, Purpose and Definition.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Agency for Healthcare Research and Quality, 
        shall establish a Primary Care Extension Program.
            ``(2) Purpose.--The Primary Care Extension Program shall 
        provide support and assistance to primary care providers to 
        educate providers about preventive medicine, health promotion, 
        chronic disease management, mental and behavioral health 
        services (including substance abuse prevention and treatment 
        services), and evidence-based and evidence-informed therapies 
        and techniques, in order to enable providers to incorporate such 
        matters into their practice and to improve community health by 
        working with community-based health connectors (referred to in 
        this section as `Health Extension Agents').
            ``(3) Definitions.--In this section:
                    ``(A) Health extension agent.--The term `Health 
                Extension Agent' means any local, community-based health 
                worker who facilitates and provides assistance to 
                primary care practices by implementing quality 
                improvement or

[[Page 124 STAT. 650]]

                system redesign, incorporating the principles of the 
                patient-centered medical home to provide high-quality, 
                effective, efficient, and safe primary care and to 
                provide guidance to patients in culturally and 
                linguistically appropriate ways, and linking practices 
                to diverse health system resources.
                    ``(B) Primary care provider.--The term `primary care 
                provider' means a clinician who provides integrated, 
                accessible health care services and who is accountable 
                for addressing a large majority of personal health care 
                needs, including providing preventive and health 
                promotion services for men, women, and children of all 
                ages, developing a sustained partnership with patients, 
                and practicing in the context of family and community, 
                as recognized by a State licensing or regulatory 
                authority, unless otherwise specified in this section.

    ``(b) Grants To Establish State Hubs and Local Primary Care 
Extension Agencies.--
            ``(1) Grants.--The Secretary shall award competitive grants 
        to States for the establishment of State- or multistate-level 
        primary care Primary Care Extension Program State Hubs (referred 
        to in this section as `Hubs').
            ``(2) Composition of hubs.--A Hub established by a State 
        pursuant to paragraph (1)--
                    ``(A) shall consist of, at a minimum, the State 
                health department, the entity responsible for 
                administering the State Medicaid program (if other than 
                the State health department), the State-level entity 
                administering the Medicare program, and the departments 
                of 1 or more health professions schools in the State 
                that train providers in primary care; and
                    ``(B) may include entities such as hospital 
                associations, primary care practice-based research 
                networks, health professional societies, State primary 
                care associations, State licensing boards, organizations 
                with a contract with the Secretary under section 1153 of 
                the Social Security Act, consumer groups, and other 
                appropriate entities.

    ``(c) State and Local Activities.--
            ``(1) Hub activities.--Hubs established under a grant under 
        subsection (b) shall--
                    ``(A) <<NOTE: Plan.>> submit to the Secretary a plan 
                to coordinate functions with quality improvement 
                organizations and area health education centers if such 
                entities are members of the Hub not described in 
                subsection (b)(2)(A);
                    ``(B) <<NOTE: Contracts.>> contract with a county- 
                or local-level entity that shall serve as the Primary 
                Care Extension Agency to administer the services 
                described in paragraph (2);
                    ``(C) organize and administer grant funds to county- 
                or local-level Primary Care Extension Agencies that 
                serve a catchment area, as determined by the State; and
                    ``(D) organize State-wide or multistate networks of 
                local-level Primary Care Extension Agencies to share and 
                disseminate information and practices.
            ``(2) Local primary care extension agency activities.--
                    ``(A) Required activities.--Primary Care Extension 
                Agencies established by a Hub under paragraph (1) 
                shall--

[[Page 124 STAT. 651]]

                          ``(i) assist primary care providers to 
                      implement a patient-centered medical home to 
                      improve the accessibility, quality, and efficiency 
                      of primary care services, including health homes;
                          ``(ii) develop and support primary care 
                      learning communities to enhance the dissemination 
                      of research findings for evidence-based practice, 
                      assess implementation of practice improvement, 
                      share best practices, and involve community 
                      clinicians in the generation of new knowledge and 
                      identification of important questions for 
                      research;
                          ``(iii) participate in a national network of 
                      Primary Care Extension Hubs and propose how the 
                      Primary Care Extension Agency will share and 
                      disseminate lessons learned and best practices; 
                      and
                          ``(iv) <<NOTE: Plan.>> develop a plan for 
                      financial sustainability involving State, local, 
                      and private contributions, to provide for the 
                      reduction in Federal funds that is expected after 
                      an initial 6-year period of program establishment, 
                      infrastructure development, and planning.
                    ``(B) Discretionary activities.--Primary Care 
                Extension Agencies established by a Hub under paragraph 
                (1) may--
                          ``(i) provide technical assistance, training, 
                      and organizational support for community health 
                      teams established under section 3602 of the 
                      Patient Protection and Affordable Care Act;
                          ``(ii) collect data and provision of primary 
                      care provider feedback from standardized 
                      measurements of processes and outcomes to aid in 
                      continuous performance improvement;
                          ``(iii) collaborate with local health 
                      departments, community health centers, tribes and 
                      tribal entities, and other community agencies to 
                      identify community health priorities and local 
                      health workforce needs, and participate in 
                      community-based efforts to address the social and 
                      primary determinants of health, strengthen the 
                      local primary care workforce, and eliminate health 
                      disparities;
                          ``(iv) develop measures to monitor the impact 
                      of the proposed program on the health of practice 
                      enrollees and of the wider community served; and
                          ``(v) participate in other activities, as 
                      determined appropriate by the Secretary.

    ``(d) Federal Program Administration.--
            ``(1) Grants; types.--Grants awarded under subsection (b) 
        shall be--
                    ``(A) program grants, that are awarded to State or 
                multistate entities that submit fully-developed plans 
                for the implementation of a Hub, for a period of 6 
                years; or
                    ``(B) planning grants, that are awarded to State or 
                multistate entities with the goal of developing a plan 
                for a Hub, for a period of 2 years.
            ``(2) Applications.--To be eligible for a grant under 
        subsection (b), a State or multistate entity shall submit to the

[[Page 124 STAT. 652]]

        Secretary an application, at such time, in such manner, and 
        containing such information as the Secretary may require.
            ``(3) <<NOTE: Appointment.>> Evaluation.--A State that 
        receives a grant under subsection (b) shall be evaluated at the 
        end of the grant period by an evaluation panel appointed by the 
        Secretary.
            ``(4) Continuing support.--After the sixth year in which 
        assistance is provided to a State under a grant awarded under 
        subsection (b), the State may receive additional support under 
        this section if the State program has received satisfactory 
        evaluations with respect to program performance and the merits 
        of the State sustainability plan, as determined by the 
        Secretary.
            ``(5) Limitation.--A State shall not use in excess of 10 
        percent of the amount received under a grant to carry out 
        administrative activities under this section. Funds awarded 
        pursuant to this section shall not be used for funding direct 
        patient care.

    ``(e) Requirements on the Secretary. <<NOTE: Consultation.>> --In 
carrying out this section, the Secretary shall consult with the heads of 
other Federal agencies with demonstrated experience and expertise in 
health care and preventive medicine, such as the Centers for Disease 
Control and Prevention, the Substance Abuse and Mental Health 
Administration, the Health Resources and Services Administration, the 
National Institutes of Health, the Office of the National Coordinator 
for Health Information Technology, the Indian Health Service, the 
Agricultural Cooperative Extension Service of the Department of 
Agriculture, and other entities, as the Secretary determines 
appropriate.

    ``(f) Authorization of Appropriations.--To awards grants as provided 
in subsection (d), there are authorized to be appropriated $120,000,000 
for each of fiscal years 2011 and 2012, and such sums as may be 
necessary to carry out this section for each of fiscal years 2013 
through 2014.''.

 Subtitle F--Strengthening Primary Care and Other Workforce Improvements

SEC. 5501. EXPANDING ACCESS TO PRIMARY CARE SERVICES AND GENERAL SURGERY 
            SERVICES.

    (a) Incentive Payment Program for Primary Care Services.--
            (1) In general.--Section 1833 of the Social Security Act (42 
        U.S.C. 1395l) is amended by adding at the end the following new 
        subsection:

    ``(x) Incentive Payments for Primary Care Services.--
            ``(1) In general. <<NOTE: Time period.>> --In the case of 
        primary care services furnished on or after January 1, 2011, and 
        before January 1, 2016, by a primary care practitioner, in 
        addition to the amount of payment that would otherwise be made 
        for such services under this part, there also shall be paid (on 
        a monthly or quarterly basis) an amount equal to 10 percent of 
        the payment amount for the service under this part.
            ``(2) Definitions.--In this subsection:
                    ``(A) Primary care practitioner.--The term `primary 
                care practitioner' means an individual--
                          ``(i) who--

[[Page 124 STAT. 653]]

                                    ``(I) is a physician (as described 
                                in section 1861(r)(1)) who has a primary 
                                specialty designation of family 
                                medicine, internal medicine, geriatric 
                                medicine, or pediatric medicine; or
                                    ``(II) is a nurse practitioner, 
                                clinical nurse specialist, or physician 
                                assistant (as those terms are defined in 
                                section 1861(aa)(5)); and
                          ``(ii) for whom primary care services 
                      accounted for at least 60 percent of the allowed 
                      charges under this part for such physician or 
                      practitioner in a prior period as determined 
                      appropriate by the Secretary.
                    ``(B) Primary care services.--The term `primary care 
                services' means services identified, as of January 1, 
                2009, by the following HCPCS codes (and as subsequently 
                modified by the Secretary):
                          ``(i) 99201 through 99215.
                          ``(ii) 99304 through 99340.
                          ``(iii) 99341 through 99350.
            ``(3) <<NOTE: Determination.>> Coordination with other 
        payments.--The amount of the additional payment for a service 
        under this subsection and subsection (m) shall be determined 
        without regard to any additional payment for the service under 
        subsection (m) and this subsection, respectively.
            ``(4) Limitation on review.--There shall be no 
        administrative or judicial review under section 1869, 1878, or 
        otherwise, respecting the identification of primary care 
        practitioners under this subsection.''.
            (2) Conforming amendment.--Section 1834(g)(2)(B) of the 
        Social Security Act (42 U.S.C. 1395m(g)(2)(B)) is amended by 
        adding at the end the following sentence: ``Section 1833(x) 
        shall not be taken into account in determining the amounts that 
        would otherwise be paid pursuant to the preceding sentence.''.

    (b) Incentive Payment Program for Major Surgical Procedures 
Furnished in Health Professional Shortage Areas.--
            (1) In general. <<NOTE: Time period.>> --Section 1833 of the 
        Social Security Act (42 U.S.C. 1395l), as amended by subsection 
        (a)(1), is amended by adding at the end the following new 
        subsection:

    ``(y) Incentive Payments for Major Surgical Procedures Furnished in 
Health Professional Shortage Areas.--
            ``(1) In general.--In the case of major surgical procedures 
        furnished on or after January 1, 2011, and before January 1, 
        2016, by a general surgeon in an area that is designated (under 
        section 332(a)(1)(A) of the Public Health Service Act) as a 
        health professional shortage area as identified by the Secretary 
        prior to the beginning of the year involved, in addition to the 
        amount of payment that would otherwise be made for such services 
        under this part, there also shall be paid (on a monthly or 
        quarterly basis) an amount equal to 10 percent of the payment 
        amount for the service under this part.
            ``(2) Definitions.--In this subsection:
                    ``(A) General surgeon.--In this subsection, the term 
                `general surgeon' means a physician (as described in 
                section 1861(r)(1)) who has designated CMS specialty 
                code 02-General Surgery as their primary specialty code 
                in the physician's enrollment under section 1866(j).
                    ``(B) Major surgical procedures.--The term `major 
                surgical procedures' means physicians' services which 
                are

[[Page 124 STAT. 654]]

                surgical procedures for which a 10-day or 90-day global 
                period is used for payment under the fee schedule under 
                section 1848(b).
            ``(3) Coordination with other payments.--The amount of the 
        additional payment for a service under this subsection and 
        subsection (m) shall be determined without regard to any 
        additional payment for the service under subsection (m) and this 
        subsection, respectively.
            ``(4) Application.--The provisions of paragraph (2) and (4) 
        of subsection (m) shall apply to the determination of additional 
        payments under this subsection in the same manner as such 
        provisions apply to the determination of additional payments 
        under subsection (m).''.
            (2) Conforming amendment.--Section 1834(g)(2)(B) of the 
        Social Security Act (42 U.S.C. 1395m(g)(2)(B)), as amended by 
        subsection (a)(2), is amended by striking ``Section 1833(x)'' 
        and inserting ``Subsections (x) and (y) of section 1833'' in the 
        last sentence.

    (c) Budget-neutrality Adjustment.--Section 1848(c)(2)(B) of the 
Social Security Act (42 U.S.C. 1395w-4(c)(2)(B)) is amended by adding at 
the end the following new clause:
                          ``(vii) Adjustment for certain physician 
                      incentive payments. <<NOTE: Applicability.>> --
                      Fifty percent of the additional expenditures under 
                      this part attributable to subsections (x) and (y) 
                      of section 1833 for a year (as estimated by the 
                      Secretary) shall be taken into account in applying 
                      clause (ii)(II) for 2011 and subsequent years. In 
                      lieu of applying the budget-neutrality adjustments 
                      required under clause (ii)(II) to relative value 
                      units to account for such costs for the year, the 
                      Secretary shall apply such budget-neutrality 
                      adjustments to the conversion factor otherwise 
                      determined for the year. For 2011 and subsequent 
                      years, the Secretary shall increase the incentive 
                      payment otherwise applicable under section 1833(m) 
                      by a percent estimated to be equal to the 
                      additional expenditures estimated under the first 
                      sentence of this clause for such year that is 
                      applicable to physicians who primarily furnish 
                      services in areas designated (under section 
                      332(a)(1)(A) of the Public Health Service Act) as 
                      health professional shortage areas.''.

SEC. 5502. MEDICARE FEDERALLY QUALIFIED HEALTH CENTER IMPROVEMENTS.

    (a)  Expansion of Medicare-Covered Preventive Services at Federally 
Qualified Health Centers.--
            (1) In general.--Section 1861(aa)(3)(A) of the Social 
        Security Act <<NOTE: 42 USC 1395x.>> (42 U.S.C. 1395w 
        (aa)(3)(A)) is amended to read as follows:
                    ``(A) services of the type described subparagraphs 
                (A) through (C) of paragraph (1) and preventive services 
                (as defined in section 1861(ddd)(3)); and''.
            (2) Effective date. <<NOTE: Applicability. 42 USC 1395x 
        note.>> --The amendment made by paragraph (1) shall apply to 
        services furnished on or after January 1, 2011.

    (b) Prospective Payment System for Federally Qualified Health 
Centers.--Section 1834 of the Social Security Act (42

[[Page 124 STAT. 655]]

U.S.C. 1395m) is amended by adding at the end the following new 
subsection:
    ``(n) Development and Implementation of Prospective Payment 
System.--
            ``(1) Development.--
                    ``(A) In general.--The Secretary shall develop a 
                prospective payment system for payment for Federally 
                qualified health services furnished by Federally 
                qualified health centers under this title. Such system 
                shall include a process for appropriately describing the 
                services furnished by Federally qualified health 
                centers.
                    ``(B) Collection of data and evaluation.--The 
                Secretary shall require Federally qualified health 
                centers to submit to the Secretary such information as 
                the Secretary may require in order to develop and 
                implement the prospective payment system under this 
                paragraph and paragraph (2), respectively, including the 
                reporting of services using HCPCS codes.
            ``(2) Implementation.--
                    ``(A) In general. <<NOTE: Effective date.>> --
                Notwithstanding section 1833(a)(3)(B), the Secretary 
                shall provide, for cost reporting periods beginning on 
                or after October 1, 2014, for payments for Federally 
                qualified health services furnished by Federally 
                qualified health centers under this title in accordance 
                with the prospective payment system developed by the 
                Secretary under paragraph (1).
                    ``(B) Payments.--
                          ``(i) Initial payments.--The Secretary shall 
                      implement such prospective payment system so that 
                      the estimated amount of expenditures under this 
                      title for Federally qualified health services in 
                      the first year that the prospective payment system 
                      is implemented is equal to 103 percent of the 
                      estimated amount of expenditures under this title 
                      that would have occurred for such services in such 
                      year if the system had not been implemented.
                          ``(ii) Payments in subsequent years.--In the 
                      year after the first year of implementation of 
                      such system, and in each subsequent year, the 
                      payment rate for Federally qualified health 
                      services furnished in the year shall be equal to 
                      the payment rate established for such services 
                      furnished in the preceding year under this 
                      subparagraph increased by the percentage increase 
                      in the MEI (as defined in 1842(i)(3)) for the year 
                      involved.''.

SEC. 5503. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS.

    (a) In General.--Section 1886(h) of the Social Security Act (42 
U.S.C. 1395ww(h)) is amended--
            (1) in paragraph (4)(F)(i), by striking ``paragraph (7)'' 
        and inserting ``paragraphs (7) and (8)'';
            (2) in paragraph (4)(H)(i), by striking ``paragraph (7)'' 
        and inserting ``paragraphs (7) and (8)'';
            (3) in paragraph (7)(E), by inserting ``or paragraph (8)'' 
        before the period at the end; and
            (4) by adding at the end the following new paragraph:
            ``(8) Distribution of additional residency positions.--

[[Page 124 STAT. 656]]

                    ``(A) Reductions in limit based on unused 
                positions.--
                          ``(i) <<NOTE: Effective date.>> In general.--
                      Except as provided in clause (ii), if a hospital's 
                      reference resident level (as defined in 
                      subparagraph (H)(i)) is less than the otherwise 
                      applicable resident limit (as defined in 
                      subparagraph (H)(iii)), effective for portions of 
                      cost reporting periods occurring on or after July 
                      1, 2011, the otherwise applicable resident limit 
                      shall be reduced by 65 percent of the difference 
                      between such otherwise applicable resident limit 
                      and such reference resident level.
                          ``(ii) Exceptions.--This subparagraph shall 
                      not apply to--
                                    ``(I) a hospital located in a rural 
                                area (as defined in subsection 
                                (d)(2)(D)(ii)) with fewer than 250 acute 
                                care inpatient beds;
                                    ``(II) <<NOTE: Deadline.>> a 
                                hospital that was part of a qualifying 
                                entity which had a voluntary residency 
                                reduction plan approved under paragraph 
                                (6)(B) or under the authority of section 
                                402 of Public Law 90-248, if the 
                                hospital demonstrates to the Secretary 
                                that it has a specified plan in place 
                                for filling the unused positions by not 
                                later than 2 years after the date of 
                                enactment of this paragraph; or
                                    ``(III) a hospital described in 
                                paragraph (4)(H)(v).
                    ``(B) Distribution.--
                          ``(i) In general.--The Secretary shall 
                      increase the otherwise applicable resident limit 
                      for each qualifying hospital that submits an 
                      application under this subparagraph by such number 
                      as the Secretary may approve for portions of cost 
                      reporting periods occurring on or after July 1, 
                      2011. The aggregate number of increases in the 
                      otherwise applicable resident limit under this 
                      subparagraph shall be equal to the aggregate 
                      reduction in such limits attributable to 
                      subparagraph (A) (as estimated by the Secretary).
                          ``(ii) Requirements.--Subject to clause (iii), 
                      a hospital that receives an increase in the 
                      otherwise applicable resident limit under this 
                      subparagraph shall ensure, during the 5-year 
                      period beginning on the date of such increase, 
                      that--
                                    ``(I) the number of full-time 
                                equivalent primary care residents, as 
                                defined in paragraph (5)(H) (as 
                                determined by the Secretary), excluding 
                                any additional positions under subclause 
                                (II), is not less than the average 
                                number of full-time equivalent primary 
                                care residents (as so determined) during 
                                the 3 most recent cost reporting periods 
                                ending prior to the date of enactment of 
                                this paragraph; and
                                    ``(II) not less than 75 percent of 
                                the positions attributable to such 
                                increase are in a primary care or 
                                general surgery residency (as determined 
                                by the Secretary).

[[Page 124 STAT. 657]]

                      The Secretary may determine whether a hospital has 
                      met the requirements under this clause during such 
                      5-year period in such manner and at such time as 
                      the Secretary determines appropriate, including at 
                      the end of such 5-year period.
                          ``(iii) Redistribution of positions if 
                      hospital no longer meets certain requirements.--In 
                      the case where the Secretary determines that a 
                      hospital described in clause (ii) does not meet 
                      either of the requirements under subclause (I) or 
                      (II) of such clause, the Secretary shall--
                                    ``(I) reduce the otherwise 
                                applicable resident limit of the 
                                hospital by the amount by which such 
                                limit was increased under this 
                                paragraph; and
                                    ``(II) provide for the distribution 
                                of positions attributable to such 
                                reduction in accordance with the 
                                requirements of this paragraph.
                    ``(C) Considerations in redistribution.--In 
                determining for which hospitals the increase in the 
                otherwise applicable resident limit is provided under 
                subparagraph (B), the Secretary shall take into 
                account--
                          ``(i) <<NOTE: Effective date.>> the 
                      demonstration likelihood of the hospital filling 
                      the positions made available under this paragraph 
                      within the first 3 cost reporting periods 
                      beginning on or after July 1, 2011, as determined 
                      by the Secretary; and
                          ``(ii) whether the hospital has an accredited 
                      rural training track (as described in paragraph 
                      (4)(H)(iv)).
                    ``(D) Priority for certain areas.--In determining 
                for which hospitals the increase in the otherwise 
                applicable resident limit is provided under subparagraph 
                (B), subject to subparagraph (E), the Secretary shall 
                distribute the increase to hospitals based on the 
                following factors:
                          ``(i) Whether the hospital is located in a 
                      State with a resident-to-population ratio in the 
                      lowest quartile (as determined by the Secretary).
                          ``(ii) Whether the hospital is located in a 
                      State, a territory of the United States, or the 
                      District of Columbia that is among the top 10 
                      States, territories, or Districts in terms of the 
                      ratio of--
                                    ``(I) the total population of the 
                                State, territory, or District living in 
                                an area designated (under such section 
                                332(a)(1)(A)) as a health professional 
                                shortage area (as of the date of 
                                enactment of this paragraph); to
                                    ``(II) the total population of the 
                                State, territory, or District (as 
                                determined by the Secretary based on the 
                                most recent available population data 
                                published by the Bureau of the Census).
                          ``(iii) Whether the hospital is located in a 
                      rural area (as defined in subsection 
                      (d)(2)(D)(ii)).
                    ``(E) Reservation of positions for certain 
                hospitals.--
                          ``(i) In general.--Subject to clause (ii), the 
                      Secretary shall reserve the positions available 
                      for distribution under this paragraph as follows:

[[Page 124 STAT. 658]]

                                    ``(I) 70 percent of such positions 
                                for distribution to hospitals described 
                                in clause (i) of subparagraph (D).
                                    ``(II) 30 percent of such positions 
                                for distribution to hospitals described 
                                in clause (ii) and (iii) of such 
                                subparagraph.
                          ``(ii) Exception if positions not 
                      redistributed by july 1, 
                      2011. <<NOTE: Deadline.>> --In the case where the 
                      Secretary does not distribute positions to 
                      hospitals in accordance with clause (i) by July 1, 
                      2011, the Secretary shall distribute such 
                      positions to other hospitals in accordance with 
                      the considerations described in subparagraph (C) 
                      and the priority described in subparagraph (D).
                    ``(F) Limitation.--A hospital may not receive more 
                than 75 full-time equivalent additional residency 
                positions under this paragraph.
                    ``(G) Application of per resident amounts for 
                primary care and nonprimary care.--With respect to 
                additional residency positions in a hospital 
                attributable to the increase provided under this 
                paragraph, the approved FTE per resident amounts are 
                deemed to be equal to the hospital per resident amounts 
                for primary care and nonprimary care computed under 
                paragraph (2)(D) for that hospital.
                    ``(H) Definitions.--In this paragraph:
                          ``(i) Reference resident level.--The term 
                      `reference resident level' means, with respect to 
                      a hospital, the highest resident level for any of 
                      the 3 most recent cost reporting periods (ending 
                      before the date of the enactment of this 
                      paragraph) of the hospital for which a cost report 
                      has been settled (or, if not, submitted (subject 
                      to audit)), as determined by the Secretary.
                          ``(ii) Resident level.--The term `resident 
                      level' has the meaning given such term in 
                      paragraph (7)(C)(i).
                          ``(iii) Otherwise applicable resident limit.--
                      The term `otherwise applicable resident limit' 
                      means, with respect to a hospital, the limit 
                      otherwise applicable under subparagraphs (F)(i) 
                      and (H) of paragraph (4) on the resident level for 
                      the hospital determined without regard to this 
                      paragraph but taking into account paragraph 
                      (7)(A).''.

    (b) IME.--
            (1) In general.--Section 1886(d)(5)(B)(v) of the Social 
        Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second 
        sentence, is amended--
                    (A) by striking ``subsection (h)(7)'' and inserting 
                ``subsections (h)(7) and (h)(8)''; and
                    (B) by striking ``it applies'' and inserting ``they 
                apply''.
            (2) Conforming amendment.--Section 1886(d)(5)(B) of the 
        Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by 
        adding at the end the following clause:
            ``(x) <<NOTE: Effective date.>> For discharges occurring on 
        or after July 1, 2011, insofar as an additional payment amount 
        under this subparagraph is attributable to resident positions 
        distributed to a hospital under subsection (h)(8)(B), the 
        indirect teaching adjustment factor shall be computed in the 
        same manner as provided under clause (ii) with respect to such 
        resident positions.''.

[[Page 124 STAT. 659]]

    (c) Conforming Amendment.--Section 422(b)(2) of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108-173) <<NOTE: 42 USC 1395ww note.>> is amended by striking 
``section 1886(h)(7)'' and all that follows and inserting ``paragraphs 
(7) and (8) of subsection (h) of section 1886 of the Social Security 
Act''.

SEC. 5504. <<NOTE: Effective dates.>>  COUNTING RESIDENT TIME IN 
            NONPROVIDER SETTINGS.

    (a) GME.--Section 1886(h)(4)(E) of the Social Security Act (42 
U.S.C. 1395ww(h)(4)(E)) is amended--
            (1) by striking ``shall be counted and that all the time'' 
        and inserting ``shall be counted and that--
                          ``(i) effective for cost reporting periods 
                      beginning before July 1, 2010, all the time;'';
            (2) in clause (i), as inserted by paragraph (1), by striking 
        the period at the end and inserting ``; and'';
            (3) by inserting after clause (i), as so inserted, the 
        following new clause:
                          ``(ii) effective for cost reporting periods 
                      beginning on or after July 1, 2010, all the time 
                      so spent by a resident shall be counted towards 
                      the determination of full-time equivalency, 
                      without regard to the setting in which the 
                      activities are performed, if a hospital incurs the 
                      costs of the stipends and fringe benefits of the 
                      resident during the time the resident spends in 
                      that setting. If more than one hospital incurs 
                      these costs, either directly or through a third 
                      party, such hospitals shall count a proportional 
                      share of the time, as determined by written 
                      agreement between the hospitals, that a resident 
                      spends training in that setting.''; and
            (4) <<NOTE: Records.>> by adding at the end the following 
        flush sentence:
                ``Any hospital claiming under this subparagraph for time 
                spent in a nonprovider setting shall maintain and make 
                available to the Secretary records regarding the amount 
                of such time and such amount in comparison with amounts 
                of such time in such base year as the Secretary shall 
                specify.''.

    (b) IME.--Section 1886(d)(5)(B)(iv) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)) is amended--
            (1) by striking ``(iv) Effective for discharges occurring on 
        or after October 1, 1997'' and inserting <<NOTE: Time 
        period.>> ``(iv)(I) Effective for discharges occurring on or 
        after October 1, 1997, and before July 1, 2010''; and
            (2) by inserting after clause (I), as inserted by paragraph 
        (1), the following new subparagraph:
            ``(II) Effective for discharges occurring on or after July 
        1, 2010, all the time spent by an intern or resident in patient 
        care activities in a nonprovider setting shall be counted 
        towards the determination of full-time equivalency if a hospital 
        incurs the costs of the stipends and fringe benefits of the 
        intern or resident during the time the intern or resident spends 
        in that setting. If more than one hospital incurs these costs, 
        either directly or through a third party, such hospitals shall 
        count a proportional share of the time, as determined by written 
        agreement between the hospitals, that a resident spends training 
        in that setting.''.

[[Page 124 STAT. 660]]

    (c) Application. <<NOTE: 42 USC 1395ww note.>> --The amendments made 
by this section shall not be applied in a manner that requires reopening 
of any settled hospital cost reports as to which there is not a 
jurisdictionally proper appeal pending as of the date of the enactment 
of this Act on the issue of payment for indirect costs of medical 
education under section 1886(d)(5)(B) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(B)) or for direct graduate medical education costs 
under section 1886(h) of such Act (42 U.S.C. 1395ww(h)).

SEC. 5505. RULES FOR COUNTING RESIDENT TIME FOR DIDACTIC AND SCHOLARLY 
            ACTIVITIES AND OTHER ACTIVITIES.

    (a) GME.--Section 1886(h) of the Social Security Act (42 U.S.C. 
1395ww(h)), as amended by section 5504, is amended--
            (1) in paragraph (4)--
                    (A) in subparagraph (E), by striking ``Such rules'' 
                and inserting ``Subject to subparagraphs (J) and (K), 
                such rules''; and
                    (B) by adding at the end the following new 
                subparagraphs:
                    ``(J) Treatment of certain nonprovider and didactic 
                activities.--Such rules shall provide that all time 
                spent by an intern or resident in an approved medical 
                residency training program in a nonprovider setting that 
                is primarily engaged in furnishing patient care (as 
                defined in paragraph (5)(K)) in non-patient care 
                activities, such as didactic conferences and seminars, 
                but not including research not associated with the 
                treatment or diagnosis of a particular patient, as such 
                time and activities are defined by the Secretary, shall 
                be counted toward the determination of full-time 
                equivalency.
                    ``(K) <<NOTE: Definition.>> Treatment of certain 
                other activities.--In determining the hospital's number 
                of full-time equivalent residents for purposes of this 
                subsection, all the time that is spent by an intern or 
                resident in an approved medical residency training 
                program on vacation, sick leave, or other approved 
                leave, as such time is defined by the Secretary, and 
                that does not prolong the total time the resident is 
                participating in the approved program beyond the normal 
                duration of the program shall be counted toward the 
                determination of full-time equivalency.''; and
            (2) in paragraph (5), by adding at the end the following new 
        subparagraph:
                    ``(K) Nonprovider setting that is primarily engaged 
                in furnishing patient care.--The term `nonprovider 
                setting that is primarily engaged in furnishing patient 
                care' means a nonprovider setting in which the primary 
                activity is the care and treatment of patients, as 
                defined by the Secretary.''.

    (b) IME Determinations.--Section 1886(d)(5)(B) of such Act (42 
U.S.C. 1395ww(d)(5)(B)) is amended by adding at the end the following 
new clause:
                          ``(x)(I) <<NOTE: Applicability.>> The 
                      provisions of subparagraph (K) of subsection 
                      (h)(4) shall apply under this subparagraph in the 
                      same manner as they apply under such subsection.
                          ``(II) In determining the hospital's number of 
                      full-time equivalent residents for purposes of 
                      this subparagraph, all the time spent by an intern 
                      or resident

[[Page 124 STAT. 661]]

                      in an approved medical residency training program 
                      in non-patient care activities, such as didactic 
                      conferences and seminars, as such time and 
                      activities are defined by the Secretary, that 
                      occurs in the hospital shall be counted toward the 
                      determination of full-time equivalency if the 
                      hospital--
                                    ``(aa) is recognized as a subsection 
                                (d) hospital;
                                    ``(bb) is recognized as a subsection 
                                (d) Puerto Rico hospital;
                                    ``(cc) is reimbursed under a 
                                reimbursement system authorized under 
                                section 1814(b)(3); or
                                    ``(dd) is a provider-based hospital 
                                outpatient department.
                          ``(III) In determining the hospital's number 
                      of full-time equivalent residents for purposes of 
                      this subparagraph, all the time spent by an intern 
                      or resident in an approved medical residency 
                      training program in research activities that are 
                      not associated with the treatment or diagnosis of 
                      a particular patient, as such time and activities 
                      are defined by the Secretary, shall not be counted 
                      toward the determination of full-time 
                      equivalency.''.

    (c) <<NOTE: Applicability. 42 USC 1395ww note.>>  Effective Dates.--
            (1) In general.--Except as otherwise provided, the Secretary 
        of Health and Human Services shall implement the amendments made 
        by this section in a manner so as to apply to cost reporting 
        periods beginning on or after January 1, 1983.
            (2) GME.--Section 1886(h)(4)(J) of the Social Security Act, 
        as added by subsection (a)(1)(B), shall apply to cost reporting 
        periods beginning on or after July 1, 2009.
            (3) IME.--Section 1886(d)(5)(B)(x)(III) of the Social 
        Security Act, as added by subsection (b), shall apply to cost 
        reporting periods beginning on or after October 1, 2001. Such 
        section, as so added, shall not give rise to any inference as to 
        how the law in effect prior to such date should be interpreted.

SEC. 5506. PRESERVATION OF RESIDENT CAP POSITIONS FROM CLOSED HOSPITALS.

    (a) GME.--Section 1886(h)(4)(H) of the Social Security Act (42 
U.S.C. Section 1395ww(h)(4)(H)) is amended by adding at the end the 
following new clause:
                          ``(vi) Redistribution of residency slots after 
                      a hospital closes.--
                                    ``(I) <<NOTE: Regulations.>> In 
                                general.--Subject to the succeeding 
                                provisions of this clause, the Secretary 
                                shall, by regulation, establish a 
                                process under which, in the case where a 
                                hospital (other than a hospital 
                                described in clause (v)) with an 
                                approved medical residency program 
                                closes on or after a date that is 2 
                                years before the date of enactment of 
                                this clause, the Secretary shall 
                                increase the otherwise applicable 
                                resident limit under this paragraph for 
                                other hospitals in accordance with this 
                                clause.
                                    ``(II) Priority for hospitals in 
                                certain areas.--Subject to the 
                                succeeding provisions of this clause, in 
                                determining for which hospitals the

[[Page 124 STAT. 662]]

                                increase in the otherwise applicable 
                                resident limit is provided under such 
                                process, the Secretary shall distribute 
                                the increase to hospitals in the 
                                following priority order (with 
                                preference given within each category to 
                                hospitals that are members of the same 
                                affiliated group (as defined by the 
                                Secretary under clause (ii)) as the 
                                closed hospital):
                                            ``(aa) First, to hospitals 
                                        located in the same core-based 
                                        statistical area as, or a core-
                                        based statistical area 
                                        contiguous to, the hospital that 
                                        closed.
                                            ``(bb) Second, to hospitals 
                                        located in the same State as the 
                                        hospital that closed.
                                            ``(cc) Third, to hospitals 
                                        located in the same region of 
                                        the country as the hospital that 
                                        closed.
                                            ``(dd) Fourth, only if the 
                                        Secretary is not able to 
                                        distribute the increase to 
                                        hospitals described in item 
                                        (cc), to qualifying hospitals in 
                                        accordance with the provisions 
                                        of paragraph (8).
                                    ``(III) Requirement hospital likely 
                                to fill position within certain time 
                                period. <<NOTE: Determination.>> --The 
                                Secretary may only increase the 
                                otherwise applicable resident limit of a 
                                hospital under such process if the 
                                Secretary determines the hospital has 
                                demonstrated a likelihood of filling the 
                                positions made available under this 
                                clause within 3 years.
                                    ``(IV) Limitation.--The aggregate 
                                number of increases in the otherwise 
                                applicable resident limits for hospitals 
                                under this clause shall be equal to the 
                                number of resident positions in the 
                                approved medical residency programs that 
                                closed on or after the date described in 
                                subclause (I).
                                    ``(V) Administration.--Chapter 35 of 
                                title 44, United States Code, shall not 
                                apply to the implementation of this 
                                clause.''.

    (b) IME.--Section 1886(d)(5)(B)(v) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(B)(v)), in the second sentence, as amended by 
section 5503, is amended by striking ``subsections (h)(7) and (h)(8)'' 
and inserting ``subsections (h)(4)(H)(vi), (h)(7), and (h)(8)''.
    (c) <<NOTE: 42 USC 1395ww note.>> Application.--The amendments made 
by this section shall not be applied in a manner that requires reopening 
of any settled hospital cost reports as to which there is not a 
jurisdictionally proper appeal pending as of the date of the enactment 
of this Act on the issue of payment for indirect costs of medical 
education under section 1886(d)(5)(B) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(B)) or for direct graduate medical education costs 
under section 1886(h) of such Act (42 U.S.C. Section 1395ww(h)).

    (d) <<NOTE: 42 USC 1395ww note.>> Effect on Temporary FTE Cap 
Adjustments.--The Secretary of Health and Human Services shall give 
consideration to the effect of the amendments made by this section on 
any temporary adjustment to a hospital's FTE cap under section 413.79(h) 
of title 42, Code of Federal Regulations (as in effect on the date of 
enactment of this Act) in order to ensure that there is no duplication 
of FTE slots. Such amendments shall not affect the

[[Page 124 STAT. 663]]

application of section 1886(h)(4)(H)(v) of the Social Security Act (42 
U.S.C. 1395ww(h)(4)(H)(v)).

    (e) Conforming Amendment.--Section 1886(h)(7)(E) of the Social 
Security Act (42 U.S.C. 1395ww(h)(7)(E)), as amended by section 5503(a), 
is amended by striking ``paragraph or paragraph (8)'' and inserting 
``this paragraph, paragraph (8), or paragraph (4)(H)(vi)''.

SEC. 5507. DEMONSTRATION PROJECTS TO ADDRESS HEALTH PROFESSIONS 
            WORKFORCE NEEDS; EXTENSION OF FAMILY-TO-FAMILY HEALTH 
            INFORMATION CENTERS.

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

``SEC. 2008. <<NOTE: 42 USC 1397g.>> DEMONSTRATION PROJECTS TO ADDRESS 
            HEALTH PROFESSIONS WORKFORCE NEEDS.

    ``(a) Demonstration Projects To Provide Low-Income Individuals With 
Opportunities for Education, Training, and Career Advancement To Address 
Health Professions Workforce Needs.--
            ``(1) Authority to award grants.--The Secretary, in 
        consultation with the Secretary of Labor, shall award grants to 
        eligible entities to conduct demonstration projects that are 
        designed to provide eligible individuals with the opportunity to 
        obtain education and training for occupations in the health care 
        field that pay well and are expected to either experience labor 
        shortages or be in high demand.
            ``(2) Requirements.--
                    ``(A) Aid and supportive services.--
                          ``(i) In general.--A demonstration project 
                      conducted by an eligible entity awarded a grant 
                      under this section shall, if appropriate, provide 
                      eligible individuals participating in the project 
                      with financial aid, child care, case management, 
                      and other supportive services.
                          ``(ii) Treatment.--Any aid, services, or 
                      incentives provided to an eligible beneficiary 
                      participating in a demonstration project under 
                      this section shall not be considered income, and 
                      shall not be taken into account for purposes of 
                      determining the individual's eligibility for, or 
                      amount of, benefits under any means-tested 
                      program.
                    ``(B) Consultation and coordination.--An eligible 
                entity applying for a grant to carry out a demonstration 
                project under this section shall demonstrate in the 
                application that the entity has consulted with the State 
                agency responsible for administering the State TANF 
                program, the local workforce investment board in the 
                area in which the project is to be conducted (unless the 
                applicant is such board), the State workforce investment 
                board established under section 111 of the Workforce 
                Investment Act of 1998, and the State Apprenticeship 
                Agency recognized under the Act of August 16, 1937 
                (commonly known as the `National Apprenticeship Act') 
                (or if no agency has been recognized in the State, the 
                Office of Apprenticeship of the Department of Labor) and 
                that the project will be carried out in coordination 
                with such entities.

[[Page 124 STAT. 664]]

                    ``(C) Assurance of opportunities for indian 
                populations. <<NOTE: Grants.>> --The Secretary shall 
                award at least 3 grants under this subsection to an 
                eligible entity that is an Indian tribe, tribal 
                organization, or Tribal College or University.
            ``(3) Reports and evaluation.--
                    ``(A) Eligible entities.--An eligible entity awarded 
                a grant to conduct a demonstration project under this 
                subsection shall submit interim reports to the Secretary 
                on the activities carried out under the project and a 
                final report on such activities upon the conclusion of 
                the entities' participation in the project. Such reports 
                shall include assessments of the effectiveness of such 
                activities with respect to improving outcomes for the 
                eligible individuals participating in the project and 
                with respect to addressing health professions workforce 
                needs in the areas in which the project is conducted.
                    ``(B) <<NOTE: Grants. Contracts.>> Evaluation.--The 
                Secretary shall, by grant, contract, or interagency 
                agreement, evaluate the demonstration projects conducted 
                under this subsection. Such evaluation shall include 
                identification of successful activities for creating 
                opportunities for developing and sustaining, 
                particularly with respect to low-income individuals and 
                other entry-level workers, a health professions 
                workforce that has accessible entry points, that meets 
                high standards for education, training, certification, 
                and professional development, and that provides 
                increased wages and affordable benefits, including 
                health care coverage, that are responsive to the 
                workforce's needs.
                    ``(C) Report to congress.--The Secretary shall 
                submit interim reports and, based on the evaluation 
                conducted under subparagraph (B), a final report to 
                Congress on the demonstration projects conducted under 
                this subsection.
            ``(4) Definitions.--In this subsection:
                    ``(A) Eligible entity.--The term `eligible entity' 
                means a State, an Indian tribe or tribal organization, 
                an institution of higher education, a local workforce 
                investment board established under section 117 of the 
                Workforce Investment Act of 1998, a sponsor of an 
                apprenticeship program registered under the National 
                Apprenticeship Act or a community-based organization.
                    ``(B) Eligible individual.--
                          ``(i) In general.--The term `eligible 
                      individual' means a individual receiving 
                      assistance under the State TANF program.
                          ``(ii) Other low-income individuals.--Such 
                      term may include other low-income individuals 
                      described by the eligible entity in its 
                      application for a grant under this section.
                    ``(C) Indian tribe; tribal organization.--The terms 
                `Indian tribe' and `tribal organization' have the 
                meaning given such terms in section 4 of the Indian 
                Self-Determination and Education Assistance Act (25 
                U.S.C. 450b).
                    ``(D) Institution of higher education.--The term 
                `institution of higher education' has the meaning given 
                that term in section 101 of the Higher Education Act of 
                1965 (20 U.S.C. 1001).

[[Page 124 STAT. 665]]

                    ``(E) State.--The term `State' means each of the 50 
                States, the District of Columbia, the Commonwealth of 
                Puerto Rico, the United States Virgin Islands, Guam, and 
                American Samoa.
                    ``(F) State tanf program.--The term `State TANF 
                program' means the temporary assistance for needy 
                families program funded under part A of title IV.
                    ``(G) Tribal college or university.--The term 
                `Tribal College or University' has the meaning given 
                that term in section 316(b) of the Higher Education Act 
                of 1965 (20 U.S.C. 1059c(b)).

    ``(b) Demonstration Project To Develop Training and Certification 
Programs for Personal or Home Care Aides.--
            ``(1) Authority to award grants. <<NOTE: Deadline.>> --Not 
        later than 18 months after the date of enactment of this 
        section, the Secretary shall award grants to eligible entities 
        that are States to conduct demonstration projects for purposes 
        of developing core training competencies and certification 
        programs for personal or home care aides. The Secretary shall--
                    ``(A) <<NOTE: Evaluation.>> evaluate the efficacy of 
                the core training competencies described in paragraph 
                (3)(A) for newly hired personal or home care aides and 
                the methods used by States to implement such core 
                training competencies in accordance with the issues 
                specified in paragraph (3)(B); and
                    ``(B) ensure that the number of hours of training 
                provided by States under the demonstration project with 
                respect to such core training competencies are not less 
                than the number of hours of training required under any 
                applicable State or Federal law or regulation.
            ``(2) Duration.--A demonstration project shall be conducted 
        under this subsection for not less than 3 years.
            ``(3) Core training competencies for personal or home care 
        aides.--
                    ``(A) In general.--The core training competencies 
                for personal or home care aides described in this 
                subparagraph include competencies with respect to the 
                following areas:
                          ``(i) The role of the personal or home care 
                      aide (including differences between a personal or 
                      home care aide employed by an agency and a 
                      personal or home care aide employed directly by 
                      the health care consumer or an independent 
                      provider).
                          ``(ii) Consumer rights, ethics, and 
                      confidentiality (including the role of proxy 
                      decision-makers in the case where a health care 
                      consumer has impaired decision-making capacity).
                          ``(iii) Communication, cultural and linguistic 
                      competence and sensitivity, problem solving, 
                      behavior management, and relationship skills.
                          ``(iv) Personal care skills.
                          ``(v) Health care support.
                          ``(vi) Nutritional support.
                          ``(vii) Infection control.
                          ``(viii) Safety and emergency training.
                          ``(ix) Training specific to an individual 
                      consumer's needs (including older individuals, 
                      younger individuals with disabilities, individuals 
                      with developmental

[[Page 124 STAT. 666]]

                      disabilities, individuals with dementia, and 
                      individuals with mental and behavioral health 
                      needs).
                          ``(x) Self-Care.
                    ``(B) Implementation.--The implementation issues 
                specified in this subparagraph include the following:
                          ``(i) The length of the training.
                          ``(ii) The appropriate trainer to student 
                      ratio.
                          ``(iii) The amount of instruction time spent 
                      in the classroom as compared to on-site in the 
                      home or a facility.
                          ``(iv) Trainer qualifications.
                          ``(v) Content for a `hands-on' and written 
                      certification exam.
                          ``(vi) Continuing education requirements.
            ``(4) Application and selection criteria.--
                    ``(A) In general.--
                          ``(i) Number of 
                      states. <<NOTE: Contracts.>> --The Secretary shall 
                      enter into agreements with not more than 6 States 
                      to conduct demonstration projects under this 
                      subsection.
                          ``(ii) Requirements for states.--An agreement 
                      entered into under clause (i) shall require that a 
                      participating State--
                                    ``(I) implement the core training 
                                competencies described in paragraph 
                                (3)(A); and
                                    ``(II) develop written materials and 
                                protocols for such core training 
                                competencies, including the development 
                                of a certification test for personal or 
                                home care aides who have completed such 
                                training competencies.
                          ``(iii) Consultation and collaboration with 
                      community and vocational colleges.--The Secretary 
                      shall encourage participating States to consult 
                      with community and vocational colleges regarding 
                      the development of curricula to implement the 
                      project with respect to activities, as applicable, 
                      which may include consideration of such colleges 
                      as partners in such implementation.
                    ``(B) Application and eligibility.--A State seeking 
                to participate in the project shall--
                          ``(i) submit an application to the Secretary 
                      containing such information and at such time as 
                      the Secretary may specify;
                          ``(ii) meet the selection criteria established 
                      under subparagraph (C); and
                          ``(iii) meet such additional criteria as the 
                      Secretary may specify.
                    ``(C) Selection criteria.--In selecting States to 
                participate in the program, the Secretary shall 
                establish criteria to ensure (if applicable with respect 
                to the activities involved)--
                          ``(i) geographic and demographic diversity;
                          ``(ii) that participating States offer medical 
                      assistance for personal care services under the 
                      State Medicaid plan;
                          ``(iii) that the existing training standards 
                      for personal or home care aides in each 
                      participating State--

[[Page 124 STAT. 667]]

                                    ``(I) are different from such 
                                standards in the other participating 
                                States; and
                                    ``(II) are different from the core 
                                training competencies described in 
                                paragraph (3)(A);
                          ``(iv) that participating States do not reduce 
                      the number of hours of training required under 
                      applicable State law or regulation after being 
                      selected to participate in the project; and
                          ``(v) that participating States recruit a 
                      minimum number of eligible health and long-term 
                      care providers to participate in the project.
                    ``(D) Technical assistance.--The Secretary shall 
                provide technical assistance to States in developing 
                written materials and protocols for such core training 
                competencies.
            ``(5) Evaluation and report.--
                    ``(A) <<NOTE: Contracts.>> Evaluation.--The 
                Secretary shall develop an experimental or control group 
                testing protocol in consultation with an independent 
                evaluation contractor selected by the Secretary. Such 
                contractor shall evaluate--
                          ``(i) the impact of core training competencies 
                      described in paragraph (3)(A), including curricula 
                      developed to implement such core training 
                      competencies, for personal or home care aides 
                      within each participating State on job 
                      satisfaction, mastery of job skills, beneficiary 
                      and family caregiver satisfaction with services, 
                      and additional measures determined by the 
                      Secretary in consultation with the expert panel;
                          ``(ii) the impact of providing such core 
                      training competencies on the existing training 
                      infrastructure and resources of States; and
                          ``(iii) whether a minimum number of hours of 
                      initial training should be required for personal 
                      or home care aides and, if so, what minimum number 
                      of hours should be required.
                    ``(B) Reports.--
                          ``(i) Report on initial implementation.--Not 
                      later than 2 years after the date of enactment of 
                      this section, the Secretary shall submit to 
                      Congress a report on the initial implementation of 
                      activities conducted under the demonstration 
                      project, including any available results of the 
                      evaluation conducted under subparagraph (A) with 
                      respect to such activities, together with such 
                      recommendations for legislation or administrative 
                      action as the Secretary determines appropriate.
                          ``(ii) Final report.--Not later than 1 year 
                      after the completion of the demonstration project, 
                      the Secretary shall submit to Congress a report 
                      containing the results of the evaluation conducted 
                      under subparagraph (A), together with such 
                      recommendations for legislation or administrative 
                      action as the Secretary determines appropriate.
            ``(6) Definitions.--In this subsection:
                    ``(A) Eligible health and long-term care provider.--
                The term `eligible health and long-term care provider' 
                means a personal or home care agency (including personal 
                or home care public authorities), a nursing home, a home 
                health agency (as defined in section 1861(o)), or

[[Page 124 STAT. 668]]

                any other health care provider the Secretary determines 
                appropriate which--
                          ``(i) is licensed or authorized to provide 
                      services in a participating State; and
                          ``(ii) receives payment for services under 
                      title XIX.
                    ``(B) Personal care services.--The term `personal 
                care services' has the meaning given such term for 
                purposes of title XIX.
                    ``(C) Personal or home care aide.--The term 
                `personal or home care aide' means an individual who 
                helps individuals who are elderly, disabled, ill, or 
                mentally disabled (including an individual with 
                Alzheimer's disease or other dementia) to live in their 
                own home or a residential care facility (such as a 
                nursing home, assisted living facility, or any other 
                facility the Secretary determines appropriate) by 
                providing routine personal care services and other 
                appropriate services to the individual.
                    ``(D) State.--The term `State' has the meaning given 
                that term for purposes of title XIX.

    ``(c) Funding.--
            ``(1) In general.--Subject to paragraph (2), out of any 
        funds in the Treasury not otherwise appropriated, there are 
        appropriated to the Secretary to carry out subsections (a) and 
        (b), $85,000,000 for each of fiscal years 2010 through 2014.
            ``(2) Training and certification programs for personal and 
        home care aides.--With respect to the demonstration projects 
        under subsection (b), the Secretary shall use $5,000,000 of the 
        amount appropriated under paragraph (1) for each of fiscal years 
        2010 through 2012 to carry out such projects. No funds 
        appropriated under paragraph (1) shall be used to carry out 
        demonstration projects under subsection (b) after fiscal year 
        2012.

    ``(d) Nonapplication.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        preceding sections of this title shall not apply to grant 
        awarded under this section.
            ``(2) Limitations on use of 
        grants. <<NOTE: Applicability.>> --Section 2005(a) (other than 
        paragraph (6)) shall apply to a grant awarded under this section 
        to the same extent and in the same manner as such section 
        applies to payments to States under this title.''.

    (b) Extension of Family-To-Family Health Information Centers.--
Section 501(c)(1)(A)(iii) of the Social Security Act (42 U.S.C. 
701(c)(1)(A)(iii)) is amended by striking ``fiscal year 2009'' and 
inserting ``each of fiscal years 2009 through 2012''.

SEC. 5508. INCREASING TEACHING CAPACITY.

    (a) Teaching Health Centers Training and Enhancement.--Part C of 
title VII of the Public Health Service Act (42 U.S.C. 293k et. seq.), as 
amended by section 5303, is further amended by inserting after section 
749 the following:

``SEC. 749A. <<NOTE: 42 USC 239l-1.>> TEACHING HEALTH CENTERS 
            DEVELOPMENT GRANTS.

    ``(a) Program Authorized.--The Secretary may award grants under this 
section to teaching health centers for the purpose of establishing new 
accredited or expanded primary care residency programs.

[[Page 124 STAT. 669]]

    ``(b) Amount and Duration.--Grants awarded under this section shall 
be for a term of not more than 3 years and the maximum award may not be 
more than $500,000.
    ``(c) Use of Funds.--Amounts provided under a grant under this 
section shall be used to cover the costs of--
            ``(1) establishing or expanding a primary care residency 
        training program described in subsection (a), including costs 
        associated with--
                    ``(A) curriculum development;
                    ``(B) recruitment, training and retention of 
                residents and faculty:
                    ``(C) accreditation by the Accreditation Council for 
                Graduate Medical Education (ACGME), the American Dental 
                Association (ADA), or the American Osteopathic 
                Association (AOA); and
                    ``(D) faculty salaries during the development phase; 
                and
            ``(2) technical assistance provided by an eligible entity.

    ``(d) Application.--A teaching health center seeking a grant under 
this section shall submit an application to the Secretary at such time, 
in such manner, and containing such information as the Secretary may 
require.
    ``(e) Preference for Certain Applications.--In selecting recipients 
for grants under this section, the Secretary shall give preference to 
any such application that documents an existing affiliation agreement 
with an area health education center program as defined in sections 751 
and 799B.
    ``(f) Definitions.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means an 
        organization capable of providing technical assistance including 
        an area health education center program as defined in sections 
        751 and 799B.
            ``(2) Primary care residency program.--The term `primary 
        care residency program' means an approved graduate medical 
        residency training program (as defined in section 340H) in 
        family medicine, internal medicine, pediatrics, internal 
        medicine-pediatrics, obstetrics and gynecology, psychiatry, 
        general dentistry, pediatric dentistry, and geriatrics.
            ``(3) Teaching health center.--
                    ``(A) In general.--The term `teaching health center' 
                means an entity that--
                          ``(i) is a community based, ambulatory patient 
                      care center; and
                          ``(ii) operates a primary care residency 
                      program.
                    ``(B) Inclusion of certain entities.--Such term 
                includes the following:
                          ``(i) A Federally qualified health center (as 
                      defined in section 1905(l)(2)(B), of the Social 
                      Security Act).
                          ``(ii) A community mental health center (as 
                      defined in section 1861(ff)(3)(B) of the Social 
                      Security Act).
                          ``(iii) A rural health clinic, as defined in 
                      section 1861(aa) of the Social Security Act.
                          ``(iv) A health center operated by the Indian 
                      Health Service, an Indian tribe or tribal 
                      organization, or an urban Indian organization (as 
                      defined in section 4 of the Indian Health Care 
                      Improvement Act).

[[Page 124 STAT. 670]]

                          ``(v) An entity receiving funds under title X 
                      of the Public Health Service Act.

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

    (c) Payments to Qualified Teaching Health Centers.--Part D of title 
III of the Public Health Service Act (42 U.S.C. 254b et seq.) is amended 
by adding at the end the following:

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

``SEC. 340H. <<NOTE: 42 USC 256h.>> PROGRAM OF PAYMENTS TO TEACHING 
            HEALTH CENTERS THAT OPERATE GRADUATE MEDICAL EDUCATION 
            PROGRAMS.

    ``(a) Payments.--Subject to subsection (h)(2), the Secretary shall 
make payments under this section for direct expenses and for indirect 
expenses to qualified teaching health centers that are listed as 
sponsoring institutions by the relevant accrediting body for expansion 
of existing or establishment of new approved graduate medical residency 
training programs.
    ``(b) Amount of Payments.--
            ``(1) In general.--Subject to paragraph (2), the amounts 
        payable under this section to qualified teaching health centers 
        for an approved graduate medical residency training program for 
        a fiscal year are each of the following amounts:
                    ``(A) Direct expense amount.--The amount determined 
                under subsection (c) for direct expenses associated with 
                sponsoring approved graduate medical residency training 
                programs.
                    ``(B) Indirect expense amount.--The amount 
                determined under subsection (d) for indirect expenses 
                associated with the additional costs relating to 
                teaching residents in such programs.
            ``(2) Capped amount.--
                    ``(A) In general.--The total of the payments made to 
                qualified teaching health centers under paragraph (1)(A) 
                or paragraph (1)(B) in a fiscal year shall not exceed 
                the amount of funds appropriated under subsection (g) 
                for such payments for that fiscal year.
                    ``(B) Limitation.--The Secretary shall limit the 
                funding of full-time equivalent residents in order to 
                ensure

[[Page 124 STAT. 671]]

                the direct and indirect payments as determined under 
                subsection (c) and (d) do not exceed the total amount of 
                funds appropriated in a fiscal year under subsection 
                (g).

    ``(c) Amount of Payment for Direct Graduate Medical Education.--
            ``(1) In general.--The amount determined under this 
        subsection for payments to qualified teaching health centers for 
        direct graduate expenses relating to approved graduate medical 
        residency training programs for a fiscal year is equal to the 
        product of--
                    ``(A) the updated national per resident amount for 
                direct graduate medical education, as determined under 
                paragraph (2); and
                    ``(B) the average number of full-time equivalent 
                residents in the teaching health center's graduate 
                approved medical residency training programs as 
                determined under section 1886(h)(4) of the Social 
                Security Act (without regard to the limitation under 
                subparagraph (F) of such section) during the fiscal 
                year.
            ``(2) Updated national per resident amount for direct 
        graduate medical education.--The updated per resident amount for 
        direct graduate medical education for a qualified teaching 
        health center for a fiscal year is an amount determined as 
        follows:
                    ``(A) Determination of qualified teaching health 
                center per resident amount.--The Secretary shall compute 
                for each individual qualified teaching health center a 
                per resident amount--
                          ``(i) by dividing the national average per 
                      resident amount computed under section 
                      340E(c)(2)(D) into a wage-related portion and a 
                      non-wage related portion by applying the 
                      proportion determined under subparagraph (B);
                          ``(ii) by multiplying the wage-related portion 
                      by the factor applied under section 1886(d)(3)(E) 
                      of the Social Security Act (but without 
                      application of section 4410 of the Balanced Budget 
                      Act of 1997 (42 U.S.C. 1395ww note)) during the 
                      preceding fiscal year for the teaching health 
                      center's area; and
                          ``(iii) by adding the non-wage-related portion 
                      to the amount computed under clause (ii).
                    ``(B) Updating rate.--The Secretary shall update 
                such per resident amount for each such qualified 
                teaching health center as determined appropriate by the 
                Secretary.

    ``(d) Amount of Payment for Indirect Medical Education.--
            ``(1) <<NOTE: Determination.>> In general.--The amount 
        determined under this subsection for payments to qualified 
        teaching health centers for indirect expenses associated with 
        the additional costs of teaching residents for a fiscal year is 
        equal to an amount determined appropriate by the Secretary.
            ``(2) Factors.--In determining the amount under paragraph 
        (1), the Secretary shall--
                    ``(A) evaluate indirect training costs relative to 
                supporting a primary care residency program in qualified 
                teaching health centers; and
                    ``(B) based on this evaluation, assure that the 
                aggregate of the payments for indirect expenses under 
                this section

[[Page 124 STAT. 672]]

                and the payments for direct graduate medical education 
                as determined under subsection (c) in a fiscal year do 
                not exceed the amount appropriated for such expenses as 
                determined in subsection (g).
            ``(3) Interim payment.--Before the Secretary makes a payment 
        under this subsection pursuant to a determination of indirect 
        expenses under paragraph (1), the Secretary may provide to 
        qualified teaching health centers a payment, in addition to any 
        payment made under subsection (c), for expected indirect 
        expenses associated with the additional costs of teaching 
        residents for a fiscal year, based on an estimate by the 
        Secretary.

    ``(e) Clarification Regarding Relationship to Other Payments for 
Graduate Medical Education.--Payments under this section--
            ``(1) shall be in addition to any payments--
                    ``(A) for the indirect costs of medical education 
                under section 1886(d)(5)(B) of the Social Security Act;
                    ``(B) for direct graduate medical education costs 
                under section 1886(h) of such Act; and
                    ``(C) for direct costs of medical education under 
                section 1886(k) of such Act;
            ``(2) shall not be taken into account in applying the 
        limitation on the number of total full-time equivalent residents 
        under subparagraphs (F) and (G) of section 1886(h)(4) of such 
        Act and clauses (v), (vi)(I), and (vi)(II) of section 
        1886(d)(5)(B) of such Act for the portion of time that a 
        resident rotates to a hospital; and
            ``(3) shall not include the time in which a resident is 
        counted toward full-time equivalency by a hospital under 
        paragraph (2) or under section 1886(d)(5)(B)(iv) of the Social 
        Security Act, section 1886(h)(4)(E) of such Act, or section 340E 
        of this Act.

    ``(f) <<NOTE: Determination.>> Reconciliation.--The Secretary shall 
determine any changes to the number of residents reported by a hospital 
in the application of the hospital for the current fiscal year to 
determine the final amount payable to the hospital for the current 
fiscal year for both direct expense and indirect expense amounts. Based 
on such determination, the Secretary shall recoup any overpayments made 
to pay any balance due to the extent possible. The final amount so 
determined shall be considered a final intermediary determination for 
the purposes of section 1878 of the Social Security Act and shall be 
subject to administrative and judicial review under that section in the 
same manner as the amount of payment under section 1186(d) of such Act 
is subject to review under such section.

    ``(g) Funding.--To carry out this section, there are appropriated 
such sums as may be necessary, not to exceed $230,000,000, for the 
period of fiscal years 2011 through 2015.
    ``(h) Annual Reporting Required.--
            ``(1) Annual report.--The report required under this 
        paragraph for a qualified teaching health center for a fiscal 
        year is a report that includes (in a form and manner specified 
        by the Secretary) the following information for the residency 
        academic year completed immediately prior to such fiscal year:
                    ``(A) The types of primary care resident approved 
                training programs that the qualified teaching health 
                center provided for residents.

[[Page 124 STAT. 673]]

                    ``(B) The number of approved training positions for 
                residents described in paragraph (4).
                    ``(C) The number of residents described in paragraph 
                (4) who completed their residency training at the end of 
                such residency academic year and care for vulnerable 
                populations living in underserved areas.
                    ``(D) Other information as deemed appropriate by the 
                Secretary.
            ``(2) Audit authority; limitation on payment.--
                    ``(A) Audit authority.--The Secretary may audit a 
                qualified teaching health center to ensure the accuracy 
                and completeness of the information submitted in a 
                report under paragraph (1).
                    ``(B) Limitation on payment.--A teaching health 
                center may only receive payment in a cost reporting 
                period for a number of such resident positions that is 
                greater than the base level of primary care resident 
                positions, as determined by the Secretary. For purposes 
                of this subparagraph, the `base level of primary care 
                residents' for a teaching health center is the level of 
                such residents as of a base period.
            ``(3) Reduction in payment for failure to report.--
                    ``(A) <<NOTE: Determination.>> In general.--The 
                amount payable under this section to a qualified 
                teaching health center for a fiscal year shall be 
                reduced by at least 25 percent if the Secretary 
                determines that--
                          ``(i) the qualified teaching health center has 
                      failed to provide the Secretary, as an addendum to 
                      the qualified teaching health center's application 
                      under this section for such fiscal year, the 
                      report required under paragraph (1) for the 
                      previous fiscal year; or
                          ``(ii) such report fails to provide complete 
                      and accurate information required under any 
                      subparagraph of such paragraph.
                    ``(B) Notice and opportunity to provide accurate and 
                missing information. <<NOTE: Deadline.>> --Before 
                imposing a reduction under subparagraph (A) on the basis 
                of a qualified teaching health center's failure to 
                provide complete and accurate information described in 
                subparagraph (A)(ii), the Secretary shall provide notice 
                to the teaching health center of such failure and the 
                Secretary's intention to impose such reduction and shall 
                provide the teaching health center with the opportunity 
                to provide the required information within the period of 
                30 days beginning on the date of such notice. If the 
                teaching health center provides such information within 
                such period, no reduction shall be made under 
                subparagraph (A) on the basis of the previous failure to 
                provide such information.
            ``(4) Residents.--The residents described in this paragraph 
        are those who are in part-time or full-time equivalent resident 
        training positions at a qualified teaching health center in any 
        approved graduate medical residency training program.

    ``(i) Regulations.--The Secretary shall promulgate regulations to 
carry out this section.
    ``(j) Definitions.--In this section:
            ``(1) Approved graduate medical residency training 
        program.--The term `approved graduate medical residency

[[Page 124 STAT. 674]]

        training program' means a residency or other postgraduate 
        medical training program--
                    ``(A) participation in which may be counted toward 
                certification in a specialty or subspecialty and 
                includes formal postgraduate training programs in 
                geriatric medicine approved by the Secretary; and
                    ``(B) that meets criteria for accreditation (as 
                established by the Accreditation Council for Graduate 
                Medical Education, the American Osteopathic Association, 
                or the American Dental Association).
            ``(2) Primary care residency program.--The term `primary 
        care residency program' has the meaning given that term in 
        section 749A.
            ``(3) Qualified teaching health center.--The term `qualified 
        teaching health center' has the meaning given the term `teaching 
        health center' in section 749A.''.

SEC. 5509. <<NOTE: 42 USC 1395ww note.>> GRADUATE NURSE EDUCATION 
            DEMONSTRATION.

    (a) In General.--
            (1) Establishment.--
                    (A) In general.--The Secretary shall establish a 
                graduate nurse education demonstration under title XVIII 
                of the Social Security Act (42 U.S.C. 1395 et seq.) 
                under which an eligible hospital may receive payment for 
                the hospital's reasonable costs (described in paragraph 
                (2)) for the provision of qualified clinical training to 
                advance practice nurses.
                    (B) Number.--The demonstration shall include up to 5 
                eligible hospitals.
                    (C) Written agreements.--Eligible hospitals selected 
                to participate in the demonstration shall enter into 
                written agreements pursuant to subsection (b) in order 
                to reimburse the eligible partners of the hospital the 
                share of the costs attributable to each partner.
            (2) Costs described.--
                    (A) In general.--Subject to subparagraph (B) and 
                subsection (d), the costs described in this paragraph 
                are the reasonable costs (as described in section 
                1861(v) of the Social Security Act (42 U.S.C. 1395x(v))) 
                of each eligible hospital for the clinical training 
                costs (as determined by the Secretary) that are 
                attributable to providing advanced practice registered 
                nurses with qualified training.
                    (B) <<NOTE: Time period.>> Limitation.--With respect 
                to a year, the amount reimbursed under subparagraph (A) 
                may not exceed the amount of costs described in 
                subparagraph (A) that are attributable to an increase in 
                the number of advanced practice registered nurses 
                enrolled in a program that provides qualified training 
                during the year and for which the hospital is being 
                reimbursed under the demonstration, as compared to the 
                average number of advanced practice registered nurses 
                who graduated in each year during the period beginning 
                on January 1, 2006, and ending on December 31, 2010 (as 
                determined by the Secretary) from the graduate nursing 
                education program operated by the applicable school of 
                nursing that is an eligible partner of the hospital for 
                purposes of the demonstration.

[[Page 124 STAT. 675]]

            (3) Waiver authority.--The Secretary may waive such 
        requirements of titles XI and XVIII of the Social Security Act 
        as may be necessary to carry out the demonstration.
            (4) Administration.--Chapter 35 of title 44, United States 
        Code, shall not apply to the implementation of this section.

    (b) Written Agreements With Eligible Partners.--No payment shall be 
made under this section to an eligible hospital unless such hospital has 
in effect a written agreement with the eligible partners of the 
hospital. Such written agreement shall describe, at a minimum--
            (1) the obligations of the eligible partners with respect to 
        the provision of qualified training; and
            (2) the obligation of the eligible hospital to reimburse 
        such eligible partners applicable (in a timely manner) for the 
        costs of such qualified training attributable to partner.

    (c) <<NOTE: Deadline. Reports.>> Evaluation.--Not later than October 
17, 2017, the Secretary shall submit to Congress a report on the 
demonstration. Such report shall include an analysis of the following:
            (1) The growth in the number of advanced practice registered 
        nurses with respect to a specific base year as a result of the 
        demonstration.
            (2) The growth for each of the specialties described in 
        subparagraphs (A) through (D) of subsection (e)(1).
            (3) The costs to the Medicare program under title XVIII of 
        the Social Security Act as a result of the demonstration.
            (4) Other items the Secretary determines appropriate and 
        relevant.

    (d) Funding.--
            (1) In general.--There is hereby appropriated to the 
        Secretary, out of any funds in the Treasury not otherwise 
        appropriated, $50,000,000 for each of fiscal years 2012 through 
        2015 to carry out this section, including the design, 
        implementation, monitoring, and evaluation of the demonstration.
            (2) Proration.--If the aggregate payments to eligible 
        hospitals under the demonstration exceed $50,000,000 for a 
        fiscal year described in paragraph (1), the Secretary shall 
        prorate the payment amounts to each eligible hospital in order 
        to ensure that the aggregate payments do not exceed such amount.
            (3) Without fiscal year limitation.--Amounts appropriated 
        under this subsection shall remain available without fiscal year 
        limitation.

    (e) Definitions.--In this section:
            (1) Advanced practice registered nurse.--The term ``advanced 
        practice registered nurse'' includes the following:
                    (A) A clinical nurse specialist (as defined in 
                subsection (aa)(5) of section 1861 of the Social 
                Security Act (42 U.S.C. 1395x)).
                    (B) A nurse practitioner (as defined in such 
                subsection).
                    (C) A certified registered nurse anesthetist (as 
                defined in subsection (bb)(2) of such section).
                    (D) A certified nurse-midwife (as defined in 
                subsection (gg)(2) of such section).
            (2) Applicable non-hospital community-based care setting.--
        The term ``applicable non-hospital community-based care 
        setting'' means a non-hospital community-based care setting 
        which has entered into a written agreement (as described in 
        subsection (b)) with the eligible hospital participating in the

[[Page 124 STAT. 676]]

        demonstration. Such settings include Federally qualified health 
        centers, rural health clinics, and other non-hospital settings 
        as determined appropriate by the Secretary.
            (3) Applicable school of nursing.--The term ``applicable 
        school of nursing'' means an accredited school of nursing (as 
        defined in section 801 of the Public Health Service Act) which 
        has entered into a written agreement (as described in subsection 
        (b)) with the eligible hospital participating in the 
        demonstration.
            (4) Demonstration.--The term ``demonstration'' means the 
        graduate nurse education demonstration established under 
        subsection (a).
            (5) Eligible hospital.--The term ``eligible hospital'' means 
        a hospital (as defined in subsection (e) of section 1861 of the 
        Social Security Act (42 U.S.C. 1395x)) or a critical access 
        hospital (as defined in subsection (mm)(1) of such section) that 
        has a written agreement in place with--
                    (A) 1 or more applicable schools of nursing; and
                    (B) 2 or more applicable non-hospital community-
                based care settings.
            (6) Eligible partners.--The term ``eligible partners'' 
        includes the following:
                    (A) An applicable non-hospital community-based care 
                setting.
                    (B) An applicable school of nursing.
            (7) Qualified training.--
                    (A) In general.--The term ``qualified training'' 
                means training--
                          (i) that provides an advanced practice 
                      registered nurse with the clinical skills 
                      necessary to provide primary care, preventive 
                      care, transitional care, chronic care management, 
                      and other services appropriate for individuals 
                      entitled to, or enrolled for, benefits under part 
                      A of title XVIII of the Social Security Act, or 
                      enrolled under part B of such title; and
                          (ii) subject to subparagraph (B), at least 
                      half of which is provided in a non-hospital 
                      community-based care setting.
                    (B) Waiver of requirement half of training be 
                provided in non-hospital community-based care setting in 
                certain areas.--The Secretary may waive the requirement 
                under subparagraph (A)(ii) with respect to eligible 
                hospitals located in rural or medically underserved 
                areas.
            (8) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

          Subtitle G--Improving Access to Health Care Services

SEC. 5601. SPENDING FOR FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS).

    (a) In General.--Section 330(r) of the Public Health Service Act (42 
U.S.C. 254b(r)) is amended by striking paragraph (1) and inserting the 
following:

[[Page 124 STAT. 677]]

            ``(1) General amounts for grants.--For the purpose of 
        carrying out this section, in addition to the amounts authorized 
        to be appropriated under subsection (d), there is authorized to 
        be appropriated the following:
                    ``(A) For fiscal year 2010, $2,988,821,592.
                    ``(B) For fiscal year 2011, $3,862,107,440.
                    ``(C) For fiscal year 2012, $4,990,553,440.
                    ``(D) For fiscal year 2013, $6,448,713,307.
                    ``(E) For fiscal year 2014, $7,332,924,155.
                    ``(F) For fiscal year 2015, $8,332,924,155.
                    ``(G) For fiscal year 2016, and each subsequent 
                fiscal year, the amount appropriated for the preceding 
                fiscal year adjusted by the product of--
                          ``(i) one plus the average percentage increase 
                      in costs incurred per patient served; and
                          ``(ii) one plus the average percentage 
                      increase in the total number of patients 
                      served.''.

    (b) Rule of Construction.--Section 330(r) of the Public Health 
Service Act (42 U.S.C. 254b(r)) is amended by adding at the end the 
following:
            ``(4) Rule of construction with respect to rural health 
        clinics.--
                    ``(A) In general.--Nothing in this section shall be 
                construed to prevent a community health center from 
                contracting with a Federally certified rural health 
                clinic (as defined in section 1861(aa)(2) of the Social 
                Security Act), a low-volume hospital (as defined for 
                purposes of section 1886 of such Act), a critical access 
                hospital, a sole community hospital (as defined for 
                purposes of section 1886(d)(5)(D)(iii) of such Act), or 
                a medicare-dependent share hospital (as defined for 
                purposes of section 1886(d)(5)(G)(iv) of such Act) for 
                the delivery of primary health care services that are 
                available at the clinic or hospital to individuals who 
                would otherwise be eligible for free or reduced cost 
                care if that individual were able to obtain that care at 
                the community health center. Such services may be 
                limited in scope to those primary health care services 
                available in that clinic or hospitals.
                    ``(B) Assurances.--In order for a clinic or hospital 
                to receive funds under this section through a contract 
                with a community health center under subparagraph (A), 
                such clinic or hospital shall establish policies to 
                ensure--
                          ``(i) nondiscrimination based on the ability 
                      of a patient to pay; and
                          ``(ii) the establishment of a sliding fee 
                      scale for low-income patients.''.

SEC. 5602. <<NOTE: Deadlines. 42 USC 254b note.>> NEGOTIATED RULEMAKING 
            FOR DEVELOPMENT OF METHODOLOGY AND CRITERIA FOR DESIGNATING 
            MEDICALLY UNDERSERVED POPULATIONS AND HEALTH PROFESSIONS 
            SHORTAGE AREAS.

    (a) Establishment.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall 
        establish, through a negotiated rulemaking process under 
        subchapter 3 of chapter 5 of title 5, United States Code, a 
        comprehensive methodology and criteria for designation of--

[[Page 124 STAT. 678]]

                    (A) medically underserved populations in accordance 
                with section 330(b)(3) of the Public Health Service Act 
                (42 U.S.C. 254b(b)(3));
                    (B) health professions shortage areas under section 
                332 of the Public Health Service Act (42 U.S.C. 254e).
            (2) Factors to consider.--In establishing the methodology 
        and criteria under paragraph (1), the Secretary--
                    (A) shall consult with relevant stakeholders who 
                will be significantly affected by a rule (such as 
                national, State and regional organizations representing 
                affected entities), State health offices, community 
                organizations, health centers and other affected 
                entities, and other interested parties; and
                    (B) shall take into account--
                          (i) the timely availability and 
                      appropriateness of data used to determine a 
                      designation to potential applicants for such 
                      designations;
                          (ii) the impact of the methodology and 
                      criteria on communities of various types and on 
                      health centers and other safety net providers;
                          (iii) the degree of ease or difficulty that 
                      will face potential applicants for such 
                      designations in securing the necessary data; and
                          (iv) the extent to which the methodology 
                      accurately measures various barriers that confront 
                      individuals and population groups in seeking 
                      health care services.

    (b) <<NOTE: Deadline.>> Publication of Notice.--In carrying out the 
rulemaking process under this subsection, the Secretary shall publish 
the notice provided for under section 564(a) of title 5, United States 
Code, by not later than 45 days after the date of the enactment of this 
Act.

    (c) Target Date for Publication of Rule.--As part of the notice 
under subsection (b), and for purposes of this subsection, the ``target 
date for publication'', as referred to in section 564(a)(5) of title 5, 
United Sates Code, shall be July 1, 2010.
    (d) <<NOTE: Deadlines.>> Appointment of Negotiated Rulemaking 
Committee and Facilitator.--The Secretary shall provide for--
            (1) the appointment of a negotiated rulemaking committee 
        under section 565(a) of title 5, United States Code, by not 
        later than 30 days after the end of the comment period provided 
        for under section 564(c) of such title; and
            (2) the nomination of a facilitator under section 566(c) of 
        such title 5 by not later than 10 days after the date of 
        appointment of the committee.

    (e) Preliminary Committee Report.--The negotiated rulemaking 
committee appointed under subsection (d) shall report to the Secretary, 
by not later than April 1, 2010, regarding the committee's progress on 
achieving a consensus with regard to the rulemaking proceeding and 
whether such consensus is likely to occur before one month before the 
target date for publication of the rule. If the committee reports that 
the committee has failed to make significant progress toward such 
consensus or is unlikely to reach such consensus by the target date, the 
Secretary may terminate such process and provide for the publication of 
a rule under this section through such other methods as the Secretary 
may provide.

[[Page 124 STAT. 679]]

    (f) Final Committee Report.--If the committee is not terminated 
under subsection (e), the rulemaking committee shall submit a report 
containing a proposed rule by not later than one month before the target 
publication date.
    (g) <<NOTE: Regulations. Federal Register, publication.>> Interim 
Final Effect.--The Secretary shall publish a rule under this section in 
the Federal Register by not later than the target publication 
date. <<NOTE: Effective date. Public information.>> Such rule shall be 
effective and final immediately on an interim basis, but is subject to 
change and revision after public notice and opportunity for a period (of 
not less than 90 days) for public comment. In connection with such rule, 
the Secretary shall specify the process for the timely review and 
approval of applications for such designations pursuant to such rules 
and consistent with this section.

    (h) Publication of Rule After Public Comment.--The Secretary shall 
provide for consideration of such comments and republication of such 
rule by not later than 1 year after the target publication date.

SEC. 5603. REAUTHORIZATION OF THE WAKEFIELD EMERGENCY MEDICAL SERVICES 
            FOR CHILDREN PROGRAM.

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

SEC. 5604. CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-BASED 
            MENTAL HEALTH SETTINGS.

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

``SEC. 520K. <<NOTE: 42 USC 290bb-42.>> AWARDS FOR CO-LOCATING PRIMARY 
            AND SPECIALTY CARE IN COMMUNITY-BASED MENTAL HEALTH 
            SETTINGS.

    ``(a) Definitions.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means a 
        qualified community mental health program defined under section 
        1913(b)(1).
            ``(2) Special populations.--The term `special populations' 
        means adults with mental illnesses who have co-occurring primary 
        care conditions and chronic diseases.

    ``(b) <<NOTE: Grants. Contracts.>> Program Authorized.--The 
Secretary, acting through the Administrator shall award grants and 
cooperative agreements to eligible entities to establish demonstration 
projects for the provision of coordinated and integrated services to 
special populations through the co-location of primary and specialty 
care services in community-based mental and behavioral health settings.

    ``(c) Application.--To be eligible to receive a grant or cooperative 
agreement under this section, an eligible entity shall submit an 
application to the Administrator at such time, in such manner,

[[Page 124 STAT. 680]]

and accompanied by such information as the Administrator may require, 
including a description of partnerships, or other arrangements with 
local primary care providers, including community health centers, to 
provide services to special populations.
    ``(d) Use of Funds.--
            ``(1) In general.--For the benefit of special populations, 
        an eligible entity shall use funds awarded under this section 
        for--
                    ``(A) the provision, by qualified primary care 
                professionals, of on site primary care services;
                    ``(B) reasonable costs associated with medically 
                necessary referrals to qualified specialty care 
                professionals, other coordinators of care or, if 
                permitted by the terms of the grant or cooperative 
                agreement, by qualified specialty care professionals on 
                a reasonable cost basis on site at the eligible entity;
                    ``(C) information technology required to accommodate 
                the clinical needs of primary and specialty care 
                professionals; or
                    ``(D) facility modifications needed to bring primary 
                and specialty care professionals on site at the eligible 
                entity.
            ``(2) Limitation.--Not to exceed 15 percent of grant or 
        cooperative agreement funds may be used for activities described 
        in subparagraphs (C) and (D) of paragraph (1).

    ``(e) <<NOTE: Deadline.>> Evaluation.--Not later than 90 days after 
a grant or cooperative agreement awarded under this section expires, an 
eligible entity shall submit to the Secretary the results of an 
evaluation to be conducted by the entity concerning the effectiveness of 
the activities carried out under the grant or agreement.

    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $50,000,000 for fiscal year 2010 
and such sums as may be necessary for each of fiscal years 2011 through 
2014.''.

SEC. 5605. <<NOTE: 36 USC 150303 note.>> KEY NATIONAL INDICATORS.

    (a) Definitions.--In this section:
            (1) Academy.--The term ``Academy'' means the National 
        Academy of Sciences.
            (2) Commission.--The term ``Commission'' means the 
        Commission on Key National Indicators established under 
        subsection (b).
            (3) Institute.--The term ``Institute'' means a Key National 
        Indicators Institute as designated under subsection (c)(3).

    (b) Commission on Key National Indicators.--
            (1) Establishment.--There is established a ``Commission on 
        Key National Indicators''.
            (2) Membership.--
                    (A) Number and appointment.--The Commission shall be 
                composed of 8 members, to be appointed equally by the 
                majority and minority leaders of the Senate and the 
                Speaker and minority leader of the House of 
                Representatives.
                    (B) Prohibited appointments.--Members of the 
                Commission shall not include Members of Congress or 
                other elected Federal, State, or local government 
                officials.
                    (C) Qualifications.--In making appointments under 
                subparagraph (A), the majority and minority leaders of

[[Page 124 STAT. 681]]

                the Senate and the Speaker and minority leader of the 
                House of Representatives shall appoint individuals who 
                have shown a dedication to improving civic dialogue and 
                decision-making through the wide use of scientific 
                evidence and factual information.
                    (D) Period of appointment.--Each member of the 
                Commission shall be appointed for a 2-year term, except 
                that 1 initial appointment shall be for 3 years. Any 
                vacancies shall not affect the power and duties of the 
                Commission but shall be filled in the same manner as the 
                original appointment and shall last only for the 
                remainder of that term.
                    (E) Date.--Members of the Commission shall be 
                appointed by not later than 30 days after the date of 
                enactment of this Act.
                    (F) Initial organizing period.---Not later than 60 
                days after the date of enactment of this Act, the 
                Commission shall develop and implement a schedule for 
                completion of the review and reports required under 
                subsection (d).
                    (G) Co-chairpersons.--The Commission shall select 2 
                Co-Chairpersons from among its members.

    (c) Duties of the Commission.--
            (1) In general.--The Commission shall--
                    (A) conduct comprehensive oversight of a newly 
                established key national indicators system consistent 
                with the purpose described in this subsection;
                    (B) make recommendations on how to improve the key 
                national indicators system;
                    (C) coordinate with Federal Government users and 
                information providers to assure access to relevant and 
                quality data; and
                    (D) <<NOTE: Contracts.>> enter into contracts with 
                the Academy.
            (2) Reports.--
                    (A) Annual report to congress.--Not later than 1 
                year after the selection of the 2 Co-Chairpersons of the 
                Commission, and each subsequent year thereafter, the 
                Commission shall prepare and submit to the appropriate 
                Committees of Congress and the President a report that 
                contains a detailed statement of the recommendations, 
                findings, and conclusions of the Commission on the 
                activities of the Academy and a designated Institute 
                related to the establishment of a Key National Indicator 
                System.
                    (B) Annual report to the academy.--
                          (i) In general.--Not later than 6 months after 
                      the selection of the 2 Co-Chairpersons of the 
                      Commission, and each subsequent year thereafter, 
                      the Commission shall prepare and submit to the 
                      Academy and a designated Institute a report making 
                      recommendations concerning potential issue areas 
                      and key indicators to be included in the Key 
                      National Indicators.
                          (ii) Limitation.--The Commission shall not 
                      have the authority to direct the Academy or, if 
                      established, the Institute, to adopt, modify, or 
                      delete any key indicators.
            (3) Contract with the national academy of sciences.--
                    (A) In general.---As soon as practicable after the 
                selection of the 2 Co-Chairpersons of the Commission, 
                the

[[Page 124 STAT. 682]]

                Co-Chairpersons shall enter into an arrangement with the 
                National Academy of Sciences under which the Academy 
                shall--
                          (i) review available public and private sector 
                      research on the selection of a set of key national 
                      indicators;
                          (ii) determine how best to establish a key 
                      national indicator system for the United States, 
                      by either creating its own institutional 
                      capability or designating an independent private 
                      nonprofit organization as an Institute to 
                      implement a key national indicator system;
                          (iii) if the Academy designates an independent 
                      Institute under clause (ii), provide scientific 
                      and technical advice to the Institute and create 
                      an appropriate governance mechanism that balances 
                      Academy involvement and the independence of the 
                      Institute; and
                          (iv) <<NOTE: Reports.>> provide an annual 
                      report to the Commission addressing scientific and 
                      technical issues related to the key national 
                      indicator system and, if established, the 
                      Institute, and governance of the Institute's 
                      budget and operations.
                    (B) Participation.--In executing the arrangement 
                under subparagraph (A), the National Academy of Sciences 
                shall convene a multi-sector, multi-disciplinary process 
                to define major scientific and technical issues 
                associated with developing, maintaining, and evolving a 
                Key National Indicator System and, if an Institute is 
                established, to provide it with scientific and technical 
                advice.
                    (C) Establishment of a key national indicator 
                system.--
                          (i) In general.--In executing the arrangement 
                      under subparagraph (A), the National Academy of 
                      Sciences shall enable the establishment of a key 
                      national indicator system by--
                                    (I) creating its own institutional 
                                capability; or
                                    (II) partnering with an independent 
                                private nonprofit organization as an 
                                Institute to implement a key national 
                                indicator system.
                          (ii) Institute.--If the Academy designates an 
                      Institute under clause (i)(II), such Institute 
                      shall be a non-profit entity (as defined for 
                      purposes of section 501(c)(3) of the Internal 
                      Revenue Code of 1986) with an educational mission, 
                      a governance structure that emphasizes 
                      independence, and characteristics that make such 
                      entity appropriate for establishing a key national 
                      indicator system.
                          (iii) Responsibilities.--Either the Academy or 
                      the Institute designated under clause (i)(II) 
                      shall be responsible for the following:
                                    (I) Identifying and selecting issue 
                                areas to be represented by the key 
                                national indicators.
                                    (II) Identifying and selecting the 
                                measures used for key national 
                                indicators within the issue areas under 
                                subclause (I).

[[Page 124 STAT. 683]]

                                    (III) Identifying and selecting data 
                                to populate the key national indicators 
                                described under subclause (II).
                                    (IV) Designing, publishing, and 
                                maintaining a public website that 
                                contains a freely accessible database 
                                allowing public access to the key 
                                national indicators.
                                    (V) Developing a quality assurance 
                                framework to ensure rigorous and 
                                independent processes and the selection 
                                of quality data.
                                    (VI) Developing a budget for the 
                                construction and management of a 
                                sustainable, adaptable, and evolving key 
                                national indicator system that reflects 
                                all Commission funding of Academy and, 
                                if an Institute is established, 
                                Institute activities.
                                    (VII) <<NOTE: Reports.>> Reporting 
                                annually to the Commission regarding its 
                                selection of issue areas, key 
                                indicators, data, and progress toward 
                                establishing a web-accessible database.
                                    (VIII) Responding directly to the 
                                Commission in response to any Commission 
                                recommendations and to the Academy 
                                regarding any inquiries by the Academy.
                          (iv) Governance.--Upon the establishment of a 
                      key national indicator system, the Academy shall 
                      create an appropriate governance mechanism that 
                      incorporates advisory and control functions. If an 
                      Institute is designated under clause (i)(II), the 
                      governance mechanism shall balance appropriate 
                      Academy involvement and the independence of the 
                      Institute.
                          (v) Modification and changes.--The Academy 
                      shall retain the sole discretion, at any time, to 
                      alter its approach to the establishment of a key 
                      national indicator system or, if an Institute is 
                      designated under clause (i)(II), to alter any 
                      aspect of its relationship with the Institute or 
                      to designate a different non-profit entity to 
                      serve as the Institute.
                          (vi) Construction.--Nothing in this section 
                      shall be construed to limit the ability of the 
                      Academy or the Institute designated under clause 
                      (i)(II) to receive private funding for activities 
                      related to the establishment of a key national 
                      indicator system.
                    (D) Annual report.--As part of the arrangement under 
                subparagraph (A), the National Academy of Sciences 
                shall, not later than 270 days after the date of 
                enactment of this Act, and annually thereafter, submit 
                to the Co-Chairpersons of the Commission a report that 
                contains the findings and recommendations of the 
                Academy.

    (d) Government Accountability Office Study and Report.--
            (1) GAO study.--The Comptroller General of the United States 
        shall conduct a study of previous work conducted by all public 
        agencies, private organizations, or foreign countries with 
        respect to best practices for a key national indicator system. 
        The study shall be submitted to the appropriate authorizing 
        committees of Congress.

[[Page 124 STAT. 684]]

            (2) GAO financial audit.--If an Institute is established 
        under this section, the Comptroller General shall conduct an 
        annual audit of the financial statements of the Institute, in 
        accordance with generally accepted government auditing standards 
        and submit a report on such audit to the Commission and the 
        appropriate authorizing committees of Congress.
            (3) GAO programmatic review.--The Comptroller General of the 
        United States shall conduct programmatic assessments of the 
        Institute established under this section as determined necessary 
        by the Comptroller General and report the findings to the 
        Commission and to the appropriate authorizing committees of 
        Congress.

    (e) Authorization of Appropriations.--
            (1) In general.---There are authorized to be appropriated to 
        carry out the purposes of this section, $10,000,000 for fiscal 
        year 2010, and $7,500,000 for each of fiscal year 2011 through 
        2018.
            (2) Availability.---Amounts appropriated under paragraph (1) 
        shall remain available until expended.

                     Subtitle H--General Provisions

SEC. 5701. <<NOTE: 42 USC 204 note.>> REPORTS.

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