(i) A skilled nursing facility (as defined in section 1819(a) of the Social Security Act (42 U.S.C. 1395i-3(a))). (ii) A nursing facility (as defined in section 1919(a) of such Act (42 U.S.C. 1396r(a))). (iii) A home health agency. (iv) A provider of hospice care (as defined in section 1861(dd)(1) of such Act (42 U.S.C. 1395x(dd)(1))). (v) A long-term care hospital (as described in section 1886(d)(1)(B)(iv) of such Act (42 U.S.C. 1395ww(d)(1)(B)(iv))). (vi) A provider of personal care services. (vii) A provider of adult day care. (viii) A residential care provider that arranges for, or directly provides, long-term care services, including an assisted living facility that provides a level of care established by the Secretary. (ix) An intermediate care facility for the mentally retarded (as defined in section 1905(d) of such Act (42 U.S.C. 1396d(d))). (x) Any other facility or provider of long-term care services under such titles as the participating State determines appropriate. (B) DIRECT PATIENT ACCESS EMPLOYEE.-The term "direct patient access employee" means any individual who has access to a patient or resident of a long-term care facility or provider through employment or through a contract with such facility or provider and has duties that involve (or may involve) one-on-one contact with a patient or resident of the facility or provider, as determined by the State for purposes of the nationwide program. Such term does not include a volunteer unless the volunteer has duties that are equivalent to the duties of a direct patient access employee and those duties involve (or may involve) one-on-one contact with a patient or resident of the long-term care facility or provider. (7) EVALUATION AND REPORT. (A) EVALUATION.-The Inspector General of the Department of Health and Human Services shall conduct an evaluation of the nationwide pro gram. (B) REPORT.-Not later than 180 days after the completion of the nationwide program, the Inspector General of the Department of Health and Human Services shall submit a report to Congress containing the results of the evaluation conducted under subparagraph (A). (b) FUNDING. (1) NOTIFICATION.-The Secretary of Health and Human Services shall notify the Secretary of the Treasury of the amount necessary to carry out the nationwide program under this section for the period of fiscal years 2010 through 2012, except that in no case shall such amount exceed $160,000,000. (2) TRANSFER OF FUNDS.-Out of any funds in the Treasury not otherwise appropriated, the Secretary of the Treasury shall provide for the transfer to the Secretary of Health and Human Services of the amount specified as necessary to carry out the nationwide program under paragraph (1). Such amount shall remain available until expended. SEC. 1910. ESTABLISHMENT OF CENTER FOR MEDICARE AND MEDICAID PAYMENT INNOVATION WITHIN CMS. (a) IN GENERAL.-Title XI of the Social Security Act is amended by inserting after section 1115 the following new section: "CENTER FOR MEDICARE AND MEDICAID PAYMENT INNOVATION "SEC. 1115A. (a) CENTER FOR MEDICARE AND MEDICAID PAYMENT INNOVATION ESTABLISHED.— "(1) IN GENERAL.-There is created within the Centers for Medicare & Medicaid Services a Center for Medicare and Medicaid Payment Innovation (in this section referred to as the 'CMPI') to carry out the duties described in paragraph (4). "(2) DIRECTOR.—The CMPI shall be headed by a Director who shall report directly to the Administrator of the Centers for Medicare & Medicaid Services. “(3) DEADLINE.-The Secretary shall ensure that the CMPI is carrying out the duties described in paragraph (4) by not later than January 1, 2011. "(4) DUTIES.-The duties described in this paragraph are the following: "(A) To carry out the duties described in this section. "(B) Such other duties as the Secretary may specify. "(5) CONSULTATION.-In carrying out the duties under paragraph (4), the CMPI shall consult representatives of relevant Federal agencies and outside clinical and analytical experts with expertise in medicine and health care man agement. The CMPI shall use open door forums or other mechanisms to seek input from interested parties. "(b) TESTING OF MODELS (PHASE I). "(1) IN GENERAL.-The CMPI shall test payment models in accordance with selection criteria under paragraph (2) to determine the effect of applying such models under title XVIII, title XIX, or both titles on program expenditures under such titles and the quality of care received by individuals receiving benefits under such titles. "(2) SELECTION OF MODELS TO BE TESTED.— "(A) IN GENERAL.-The Secretary shall give preference to testing models for which, as determined by the professional staff at the Centers for Medicare & Medicaid Services and using such input from outside the Centers as the Secretary determines appropriate, there is evidence that the model addresses a defined population for which there are deficits in care leading to poor clinical outcomes or potentially avoidable expenditures. The Secretary shall focus on models expected to reduce program costs under title XVIII, title XIX, or both titles while preserving or enhancing the quality of care received by individuals receiving benefits under such titles. "(B) APPLICATION TO OTHER DEMONSTRATIONS.-The Secretary shall operate the demonstration programs under sections 1222 and 1236 of the America's Affordable Health Choices Act of 2009 through the CMPI in accordance with the rules applicable under this section, including those relating to evaluations, terminations, and expansions. "(3) BUDGET NEUTRALITY.— “(A) INITIAL PERIOD.-The Secretary shall not require as a condition for testing a model under paragraph (1) that the design of the model ensure that the model is budget neutral initially with respect to expenditures under titles XVIII and XIX. "(B) TERMINATION.-The Secretary shall terminate or modify the design and implementation of a model unless the Secretary determines (and the Chief Actuary of the Centers for Medicare & Medicaid Services, with respect to spending under such titles, certifies), after testing has begun, that the model is expected to "(i) improve the quality of patient care (as determined by the Administrator of the Centers for Medicare & Medicaid Services) without increasing spending under such titles; "(ii) reduce spending under such titles without reducing the quality of patient care; or "(iii) do both. Such termination may occur at any time after such testing has begun and before completion of the testing. "(4) EVALUATION.-The Secretary shall conduct an evaluation of each model tested under this subsection. Such evaluation shall include an analysis of "(A) the quality of patient care furnished under the model, including through the use of patient-level outcomes measures; and "(B) the changes in spending under titles XVIII and XIX by reason of the model. The Secretary shall make the results of each evaluation under this paragraph available to the public in a timely fashion. "(c) EXPANSION OF MODELS (PHASE II).—The Secretary may expand the duration and the scope of a model that is being tested under subsection (b) (including implementation on a nationwide basis), to the extent determined appropriate by the Secretary, if— "(1) the Secretary determines that such expansion is expected "(A) to improve the quality of patient care without increasing spending under titles XVIII and XIX; "(B) to reduce spending under such titles without reducing the quality of patient care; or "(C) to do both; and "(2) the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that such expansion would reduce (or not result in any increase in) net program spending under such titles. "(d) IMPLEMENTATION. “(1) WAIVER AUTHORITY.-The Secretary may waive such requirements of title XVIII and of sections 1902(a)(1), 1902(a)(13), and 1903(m)(2)(A)(iii) as may be necessary solely for purposes of carrying out this section with respect to testing models described in subsection (b). "(2) LIMITATIONS ON REVIEW.-There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of "(A) the selection of models for testing or expansion under this section; "(B) the elements, parameters, scope, and duration of such models for testing or dissemination; "(C) the termination or modification of the design and implementation of a model under subsection (b)(3)(B); and "(D) determinations about expansion of the duration and scope of a model under subsection (c) including the determination that a model is not expected to meet criteria described in paragraphs (1) or (2) of such subsection. "(3) ADMINISTRATION.-Chapter 35 of title 44, United States Code shall not apply to this section and testing and evaluation of models or expansion of such models under this section. “(4) FUNDING FOR TESTING ITEMS AND SERVICES AND ADMINISTRATIVE COSTS.— There shall be available from the Federal Supplementary Medical Insurance Trust Fund for payments for designing, conducting, and evaluating payment models, as well as for additional benefits for items and services under models tested under subsection (b) not otherwise covered under this title and the evaluation of such models, $350,000,000 for fiscal year 2010 and, for a subsequent fiscal year, the amount determined under this sentence for the preceding fiscal year increased by the annual percentage rate of increase in total expenditures under this title for the previous fiscal year. There are also appropriated, from any amounts in the Treasury not otherwise appropriated, $25,000,000 for each fiscal year (beginning with fiscal year 2010) for administrative costs of administering this section with respect to the Medicaid program under title XIX of the Social Security Act. "(e) REPORT TO CONGRESS.-Beginning in 2012, and not less than once every other year thereafter, the Secretary shall submit to Congress a report on activities under this section. Each such report shall describe the payment models tested under subsection (b), any models chosen for expansion under subsection (c), and the results from evaluations under subsection (b)(4). In addition, each such report shall provide such recommendations as the Secretary believes are appropriate for legislative action to facilitate the development and expansion of successful payment models.". (b) MEDICAID CONFORMING AMENDMENT.-Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by sections 1631(b), 1703(a), 1729, 1753, 1757(a), and 1759(a), is amended (1) in paragraph (78), by striking "and" at the end; (2) in paragraph (79), by striking the period at the end and inserting "; and"; and (3) by inserting after paragraph (79) the following new paragraph: "(80) provide for implementation of the payment models specified by the Secretary under section 1115A(c) for implementation on a nationwide basis unless the State demonstrates to the satisfaction of the Secretary that implementation would not be administratively feasible or appropriate to the health care delivery system of the State.". DIVISION C-PUBLIC HEALTH AND SEC. 2001. TABLE OF CONTENTS; REFERENCES. (a) TABLE OF CONTENTS.-The table of contents of this division is as follows: Sec. 2001. Table of contents; references. Sec. 2002. Public Health Investment Fund. TITLE I-COMMUNITY HEALTH CENTERS Sec. 2101. Increased funding. TITLE II-WORKFORCE Subtitle A—Primary Care Workforce PART 1-NATIONAL HEALTH SERVICE CORPS Sec. 2201. National Health Service Corps. Sec. 2202. Authorizations of appropriations. PART 2-PROMOTION OF PRIMARY CARE AND DENTISTRY Sec. 2211. Frontline health providers. Sec. 2212. Primary care student loan funds. Sec. 2213. Training in family medicine, general internal medicine, general pediatrics, geriatrics, and physician assistants. Sec. 2214. Training of medical residents in community-based settings. Sec. 2215. Training for general, pediatric, and public health dentists and dental hygienists. Sec. 2216. Authorization of appropriations. Sec. 2217. Study on effectiveness of scholarships and loan repayments. Subtitle B-Nursing Workforce Sec. 2221. Amendments to Public Health Service Act. Subtitle C-Public Health Workforce Sec. 2231. Public Health Workforce Corps. Sec. 2232. Enhancing the public health workforce. Sec. 2234. Preventive medicine and public health training grant program. Subtitle D-Adapting Workforce to Evolving Health System Needs PART 1-HEALTH PROFESSIONS TRAINING FOR DIVERSITY Sec. 2241. Scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistance in the health professions regarding individuals from disadvantaged backgrounds. Sec. 2242. Nursing workforce diversity grants. Sec. 2243. Coordination of diversity and cultural competency programs. PART 2-INTERDISCIPLINARY TRAINING PROGRAMS Sec. 2251. Cultural and linguistic competency training for health professionals. Sec. 2252. Innovations in interdisciplinary care training. PART 3—ADVISORY COMMITTEE ON HEALTH WORKFORCE EVALUATION AND ASSESSMENT Sec. 2261. Health workforce evaluation and assessment. PART 4-HEALTH WORKFORCE ASSESSMENT Sec. 2271. Health workforce assessment. PART 5-AUTHORIZATION OF APPROPRIATIONS Sec. 2281. Authorization of appropriations. TITLE III-PREVENTION AND WELLNESS Sec. 2301. Prevention and wellness. "TITLE XXXI-PREVENTION AND WELLNESS "Sec. 3111. Prevention and Wellness Trust. "Subtitle B-National Prevention and Wellness Strategy "Sec. 3121. National Prevention and Wellness Strategy. "Subtitle C-Prevention Task Forces "Sec. 3131. Task Force on Clinical Preventive Services. "Subtitle D-Prevention and Wellness Research "Sec. 3141. Prevention and wellness research activity coordination. "Sec. 3142. Community prevention and wellness research grants. "Subtitle E-Delivery of Community Prevention and Wellness Services "Sec. 3151. Community prevention and wellness services grants. "Subtitle F-Core Public Health Infrastructure "Sec. 3161. Core public health infrastructure for State, local, and tribal health departments. "Sec. 3162. Core public health infrastructure and activities for CDC. "Subtitle G-General Provisions "Sec. 3171. Definitions. TITLE IV-QUALITY AND SURVEILLANCE Sec. 2401. Implementation of best practices in the delivery of health care. Sec. 2403. Authorization of appropriations. TITLE V-OTHER PROVISIONS Subtitle A—Drug Discount for Rural and Other Hospitals Sec. 2501. Expanded participation in 340B program. Subtitle B-Programs PART 1-GRANTS FOR CLINICS AND CENTERS Sec. 2511. School-based health clinics. Sec. 2512. Nurse-managed health centers. Sec. 2513. Federally qualified behavioral health centers. PART 2 OTHER GRANT PROGRAMS Sec. 2521. Comprehensive programs to provide education to nurses and create a pipeline to nursing. Sec. 2523. Programs to increase awareness of advance care planning issues. Sec. 2524. Reauthorization of telehealth and telemedicine grant programs. Sec. 2525. No child left unimmunized against influenza: demonstration program using elementary and secondary schools as influenza vaccination centers. Sec. 2526. Extension of Wisewoman Program. Sec. 2527. Healthy teen initiative to prevent teen pregnancy. Sec. 2528. National training initiative on autism supplemental grants and technical assistance. Sec. 2529. Implementation of medication management services in treatment of chronic diseases. Sec. 2530. Postpartum depression. Sec. 2531. Grants to promote positive health behaviors and outcomes. PART 3-EMERGENCY CARE-RELATED PROGRAMS Sec. 2541. Trauma care centers. Sec. 2542. Emergency care coordination. Sec. 2543. Pilot programs to improve emergency medical care. Sec. 2544. Assisting veterans with military emergency medical training to become State-licensed or certified emergency medical technicians (EMTs). Sec. 2545. Dental emergency responders: public health and medical response. Sec. 2546. Dental emergency responders: homeland security. PART 4-PAIN CARE AND MANAGEMENT PROGRAMS Sec. 2551. Institute of Medicine Conference on Pain. Subtitle C-Food and Drug Administration Sec. 2561. National medical device registry. PART 1-IN GENERAL Sec. 2562. Nutrition labeling of standard menu items at chain restaurants and of articles of food sold from vending machines. Sec. 2563. Protecting consumer access to generic drugs. PART 2-BIOSIMILARS Sec. 2565. Licensure pathway for biosimilar biological products. Sec. 2566. Fees relating to biosimilar biological products. Subtitle D-Community Living Assistance Services and Supports Sec. 2571. Establishment of national voluntary insurance program for purchasing community living assistance services and supports. Subtitle E-Miscellaneous Sec. 2581. States failing to adhere to certain employment obligations. Sec. 2582. Study, report, and termination of duplicative grant programs. Sec. 2583. Health centers under Public Health Service Act; liability protections for volunteer practitioners. Sec. 2584. Report to Congress on the current state of parasitic diseases that have been overlooked among the poorest Americans. Sec. 2585. Study of impact of optometrists on access to health care and on availability of support under Federal health programs for optometry. (b) REFERENCES.-Except as otherwise specified, whenever in this division an amendment is expressed in terms of an amendment to a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act (42 U.S.C. 201 et seq.). SEC. 2002. PUBLIC HEALTH INVESTMENT FUND. (a) ESTABLISHMENT OF FUNDS. (1) IN GENERAL.-There is established a fund to be known as the Public Health Investment Fund (referred to in this section as the "Fund"). (2) FUNDING. (A) There shall be deposited into the Fund— (i) for fiscal year 2010, $4,600,000,000; (ii) for fiscal year 2011, $5,600,000,000; (iii) for fiscal year 2012, $6,900,000,000; (iv) for fiscal year 2013, $7,800,000,000; and (v) for fiscal year 2014, $9,000,000,000. (B) Amounts deposited into the Fund shall be derived from general revenues of the Treasury. (b) AUTHORIZATION OF APPROPRIATIONS FROM THE FUND.(1) NEW FUNDING.— (A) IN GENERAL.-Amounts in the Fund are authorized to be appropriated by the Committees on Appropriations of the House of Representatives and the Senate for carrying out activities under designated public health provi sions. |