Section 10501

SEC. 10501. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT, THE SOCIAL SECURITY ACT, AND TITLE V OF THIS ACT.

[a] Section 5101 of this Act is amended--

[1] in subsection [c][2][B][i][II], by inserting ', including representatives of small business and self-employed individuals' after 'employers';

[2] in subsection [d][4][A]--

[A] by redesignating clause [iv] as clause [v]; and

[B] by inserting after clause [iii] the following:

'[iv] An analysis of, and recommendations for, eliminating the barriers to entering and staying in primary care, including provider compensation.'; and

[3] in subsection [i][2][B], by inserting 'optometrists, ophthalmologists,' after 'occupational therapists,'.

[b] Subtitle B of title V of this Act is amended by adding at the end the following:

'SEC. 5104. INTERAGENCY TASK FORCE TO ASSESS AND IMPROVE ACCESS TO HEALTH CARE IN THE STATE OF ALASKA.

'[a] Establishment- There is established a task force to be known as the 'Interagency Access to Health Care in Alaska Task Force' [referred to in this section as the 'Task Force'].

'[b] Duties- The Task Force shall--

'[1] assess access to health care for beneficiaries of Federal health care systems in Alaska; and

'[2] develop a strategy for the Federal Government to improve delivery of health care to Federal beneficiaries in the State of Alaska.

'[c] Membership- The Task Force shall be comprised of Federal members who shall be appointed, not later than 45 days after the date of enactment of this Act, as follows:

'[1] The Secretary of Health and Human Services shall appoint one representative of each of the following:

'[A] The Department of Health and Human Services.

'[B] The Centers for Medicare and Medicaid Services.

'[C] The Indian Health Service.

'[2] The Secretary of Defense shall appoint one representative of the TRICARE Management Activity.

'[3] The Secretary of the Army shall appoint one representative of the Army Medical Department.

'[4] The Secretary of the Air Force shall appoint one representative of the Air Force, from among officers at the Air Force performing medical service functions.

'[5] The Secretary of Veterans Affairs shall appoint one representative of each of the following:

'[A] The Department of Veterans Affairs.

'[B] The Veterans Health Administration.

'[6] The Secretary of Homeland Security shall appoint one representative of the United States Coast Guard.

'[d] Chairperson- One chairperson of the Task Force shall be appointed by the Secretary at the time of appointment of members under subsection [c], selected from among the members appointed under paragraph [1].

'[e] Meetings- The Task Force shall meet at the call of the chairperson.

'[f] Report- Not later than 180 days after the date of enactment of this Act, the Task Force shall submit to Congress a report detailing the activities of the Task Force and containing the findings, strategies, recommendations, policies, and initiatives developed pursuant to the duty described in subsection [b][2]. In preparing such report, the Task Force shall consider completed and ongoing efforts by Federal agencies to improve access to health care in the State of Alaska.

'[g] Termination- The Task Force shall be terminated on the date of submission of the report described in subsection [f].'.

[c] Section 399V of the Public Health Service Act, as added by section 5313, is amended--

[1] in subsection [b][4], by striking 'identify, educate, refer, and enroll' and inserting 'identify and refer'; and

[2] in subsection [k][1], by striking ', as defined by the Department of Labor as Standard Occupational Classification [21-1094]'.

[d] Section 738[a][3] of the Public Health Service Act [42 U.S.C. 293b[a][3]] is amended by inserting 'schools offering physician assistant education programs,' after 'public health,'.

[e] Subtitle D of title V of this Act is amended by adding at the end the following:

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

'[a] Establishment of Program- The Secretary of Health and Human Services [referred to in this section as the 'Secretary'] shall establish a training demonstration program for family nurse practitioners [referred to in this section as the 'program'] to employ and provide 1-year training for nurse practitioners who have graduated from a nurse practitioner program for careers as primary care providers in Federally qualified health centers [referred to in this section as 'FQHCs'] and nurse-managed health clinics [referred to in this section as 'NMHCs'].

'[b] Purpose- The purpose of the program is to enable each grant recipient to--

'[1] provide new nurse practitioners with clinical training to enable them to serve as primary care providers in FQHCs and NMHCs;

'[2] train new nurse practitioners to work under a model of primary care that is consistent with the principles set forth by the Institute of Medicine and the needs of vulnerable populations; and

'[3] create a model of FQHC and NMHC training for nurse practitioners that may be replicated nationwide.

'[c] Grants- The Secretary shall award 3-year grants to eligible entities that meet the requirements established by the Secretary, for the purpose of operating the nurse practitioner primary care programs described in subsection [a] in such entities.

'[d] Eligible Entities- To be eligible to receive a grant under this section, an entity shall--

'[1][A] be a FQHC as defined in section 1861[aa] of the Social Security Act [42 U.S.C. 1395x[aa]]; or

'[B] be a nurse-managed health clinic, as defined in section 330A-1 of the Public Health Service Act [as added by section 5208 of this Act]; and

'[2] submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

'[e] Priority in Awarding Grants- In awarding grants under this section, the Secretary shall give priority to eligible entities that--

'[1] demonstrate sufficient infrastructure in size, scope, and capacity to undertake the requisite training of a minimum of 3 nurse practitioners per year, and to provide to each awardee 12 full months of full-time, paid employment and benefits consistent with the benefits offered to other full-time employees of such entity;

'[2] will assign not less than 1 staff nurse practitioner or physician to each of 4 precepted clinics;

'[3] will provide to each awardee specialty rotations, including specialty training in prenatal care and women's health, adult and child psychiatry, orthopedics, geriatrics, and at least 3 other high-volume, high-burden specialty areas;

'[4] provide sessions on high-volume, high-risk health problems and have a record of training health care professionals in the care of children, older adults, and underserved populations; and

'[5] collaborate with other safety net providers, schools, colleges, and universities that provide health professions training.

'[f] Eligibility of Nurse Practitioners-

'[1] IN GENERAL- To be eligible for acceptance to a program funded through a grant awarded under this section, an individual shall--

'[A] be licensed or eligible for licensure in the State in which the program is located as an advanced practice registered nurse or advanced practice nurse and be eligible or board-certified as a family nurse practitioner; and

'[B] demonstrate commitment to a career as a primary care provider in a FQHC or in a NMHC.

'[2] PREFERENCE- In selecting awardees under the program, each grant recipient shall give preference to bilingual candidates that meet the requirements described in paragraph [1].

'[3] DEFERRAL OF CERTAIN SERVICE- The starting date of required service of individuals in the National Health Service Corps Service program under title II of the Public Health Service Act [42 U.S.C. 202 et seq.] who receive training under this section shall be deferred until the date that is 22 days after the date of completion of the program.

'[g] Grant Amount- Each grant awarded under this section shall be in an amount not to exceed $600,000 per year. A grant recipient may carry over funds from 1 fiscal year to another without obtaining approval from the Secretary.

'[h] Technical Assistance Grants- The Secretary may award technical assistance grants to 1 or more FQHCs or NMHCs that have demonstrated expertise in establishing a nurse practitioner residency training program. Such technical assistance grants shall be for the purpose of providing technical assistance to other recipients of grants under subsection [c].

'[i] Authorization of Appropriations- To carry out this section, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2011 through 2014.'.

[f][1] Section 399W of the Public Health Service Act, as added by section 5405, is redesignated as section 399V-1.

[2] Section 399V-1 of the Public Health Service Act, as so redesignated, is amended in subsection [b][2][A] by striking 'and the departments of 1 or more health professions schools in the State that train providers in primary care' and inserting 'and the departments that train providers in primary care in 1 or more health professions schools in the State'.

[3] Section 934 of the Public Health Service Act, as added by section 3501, is amended by striking '399W' each place such term appears and inserting '399V-1'.

[4] Section 935[b] of the Public Health Service Act, as added by section 3503, is amended by striking '399W' and inserting '399V-1'.

[g] Part P of title III of the Public Health Service Act 42 U.S.C. 280g et seq.], as amended by section 10411, is amended by adding at the end the following:

'SEC. 399V-3. NATIONAL DIABETES PREVENTION PROGRAM.

'[a] In General- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a national diabetes prevention program [referred to in this section as the 'program'] targeted at adults at high risk for diabetes in order to eliminate the preventable burden of diabetes.

'[b] Program Activities- The program described in subsection [a] shall include--

'[1] a grant program for community-based diabetes prevention program model sites;

'[2] a program within the Centers for Disease Control and Prevention to determine eligibility of entities to deliver community-based diabetes prevention services;

'[3] a training and outreach program for lifestyle intervention instructors; and

'[4] evaluation, monitoring and technical assistance, and applied research carried out by the Centers for Disease Control and Prevention.

'[c] Eligible Entities- To be eligible for a grant under subsection [b][1], an entity shall be a State or local health department, a tribal organization, a national network of community-based non-profits focused on health and wellbeing, an academic institution, or other entity, as the Secretary determines.

'[d] Authorization of Appropriations- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2010 through 2014.'.

[h] The provisions of, and amendment made by, section 5501[c] of this Act are repealed.

[i][1] The provisions of, and amendments made by, section 5502 of this Act are repealed.

[2][A] Section 1861[aa][3][A] of the Social Security Act [42 U.S.C. 1395w[aa][3][A]] is amended to read as follows:

'[A] services of the type described in subparagraphs [A] through [C] of paragraph [1] and preventive services [as defined in section 1861[ddd][3]]; and'.

[B] The amendment made by subparagraph [A] shall apply to services furnished on or after January 1, 2011.

[3][A] Section 1834 of the Social Security Act [42 U.S.C. 1395m], as amended by section 4105, is amended by adding at the end the following new subsection:

'[o] 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 center 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 and shall establish payment rates for specific payment codes based on such appropriate descriptions of services. Such system shall be established to take into account the type, intensity, and duration of services furnished by Federally qualified health centers. Such system may include adjustments, including geographic adjustments, determined appropriate by the Secretary.

'[B] COLLECTION OF DATA AND EVALUATION- By not later than January 1, 2011, 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 subsection, including the reporting of services using HCPCS codes.

'[2] IMPLEMENTATION-

'[A] IN GENERAL- Notwithstanding section 1833[a][3][A], the Secretary shall provide, for cost reporting periods beginning on or after October 1, 2014, for payments of prospective payment rates for Federally qualified health center 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 aggregate amount of prospective payment rates [determined prior to the application of section 1833[a][1][Z]] under this title for Federally qualified health center services in the first year that such system is implemented is equal to 100 percent of the estimated amount of reasonable costs [determined without the application of a per visit payment limit or productivity screen and prior to the application of section 1866[a][2][A][ii]] that would have occurred for such services under this title in such year if the system had not been implemented.

'[ii] PAYMENTS IN SUBSEQUENT YEARS- Payment rates in years after the year of implementation of such system shall be the payment rates in the previous year increased--

'[I] in the first year after implementation of such system, by the percentage increase in the MEI [as defined in section 1842[i][3]] for the year involved; and

'[II] in subsequent years, by the percentage increase in a market basket of Federally qualified health center goods and services as promulgated through regulations, or if such an index is not available, by the percentage increase in the MEI [as defined in section 1842[i][3]] for the year involved.

'[C] PREPARATION FOR PPS IMPLEMENTATION- Notwithstanding any other provision of law, the Secretary may establish and implement by program instruction or otherwise the payment codes to be used under the prospective payment system under this section.'.

[B] Section 1833[a][1] of the Social Security Act [42 U.S.C. 1395l[a][1]], as amended by section 4104, is amended--

[i] by striking 'and' before '[Y]'; and

[ii] by inserting before the semicolon at the end the following: ', and [Z] with respect to Federally qualified health center services for which payment is made under section 1834[o], the amounts paid shall be 80 percent of the lesser of the actual charge or the amount determined under such section'.

[C] Section 1833[a] of the Social Security Act [42 U.S.C. 1395l[a]] is amended--

[i] in paragraph [3][B][i]--

[I] by inserting '[I]' after 'otherwise been provided'; and

[II] by inserting ', or [II] in the case of such services furnished on or after the implementation date of the prospective payment system under section 1834[o], under such section [calculated as if '100 percent' were substituted for '80 percent' in such section] for such services if the individual had not been so enrolled' after 'been so enrolled'; and

[ii] by adding at the end the following flush sentence:

'Paragraph [3][A] shall not apply to Federally qualified health center services furnished on or after the implementation date of the prospective payment system under section 1834[0].'.

[j] Section 5505 is amended by adding at the end the following new subsection:

'[d] Application- The amendments made by this section shall not be applied in a manner that requires reopening of any settled 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]].'.

[k] Subtitle G of title V of this Act is amended by adding at the end the following:

'SEC. 5606. STATE GRANTS TO HEALTH CARE PROVIDERS WHO PROVIDE SERVICES TO A HIGH PERCENTAGE OF MEDICALLY UNDERSERVED POPULATIONS OR OTHER SPECIAL POPULATIONS.

'[a] In General- A State may award grants to health care providers who treat a high percentage, as determined by such State, of medically underserved populations or other special populations in such State.

'[b] Source of Funds- A grant program established by a State under subsection [a] may not be established within a department, agency, or other entity of such State that administers the Medicaid program under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.], and no Federal or State funds allocated to such Medicaid program, the Medicare program under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], or the TRICARE program under chapter 55 of title 10, United States Code, may be used to award grants or to pay administrative costs associated with a grant program established under subsection [a].'.

[l] Part C of title VII of the Public Health Service Act [42 U.S.C. 293k et seq.] is amended--

[1] after the part heading, by inserting the following:

'Subpart I--Medical Training Generally';

and

[2] by inserting at the end the following:

'Subpart II--Training in Underserved Communities 'SEC. 749B. RURAL PHYSICIAN TRAINING GRANTS.

'[a] In General- The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish a grant program for the purposes of assisting eligible entities in recruiting students most likely to practice medicine in underserved rural communities, providing rural-focused training and experience, and increasing the number of recent allopathic and osteopathic medical school graduates who practice in underserved rural communities.

'[b] Eligible Entities- In order to be eligible to receive a grant under this section, an entity shall--

'[1] be a school of allopathic or osteopathic medicine accredited by a nationally recognized accrediting agency or association approved by the Secretary for this purpose, or any combination or consortium of such schools; and

'[2] submit an application to the Secretary that includes a certification that such entity will use amounts provided to the institution as described in subsection [d][1].

'[c] Priority- In awarding grant funds under this section, the Secretary shall give priority to eligible entities that--

'[1] demonstrate a record of successfully training students, as determined by the Secretary, who practice medicine in underserved rural communities;

'[2] demonstrate that an existing academic program of the eligible entity produces a high percentage, as determined by the Secretary, of graduates from such program who practice medicine in underserved rural communities;

'[3] demonstrate rural community institutional partnerships, through such mechanisms as matching or contributory funding, documented in-kind services for implementation, or existence of training partners with interprofessional expertise in community health center training locations or other similar facilities; or

'[4] submit, as part of the application of the entity under subsection [b], a plan for the long-term tracking of where the graduates of such entity practice medicine.

'[d] Use of Funds-

'[1] ESTABLISHMENT- An eligible entity receiving a grant under this section shall use the funds made available under such grant to establish, improve, or expand a rural-focused training program [referred to in this section as the 'Program'] meeting the requirements described in this subsection and to carry out such program.

'[2] STRUCTURE OF PROGRAM- An eligible entity shall--

'[A] enroll no fewer than 10 students per class year into the Program; and

'[B] develop criteria for admission to the Program that gives priority to students--

'[i] who have originated from or lived for a period of 2 or more years in an underserved rural community; and

'[ii] who express a commitment to practice medicine in an underserved rural community.

'[3] CURRICULA- The Program shall require students to enroll in didactic coursework and clinical experience particularly applicable to medical practice in underserved rural communities, including--

'[A] clinical rotations in underserved rural communities, and in applicable specialties, or other coursework or clinical experience deemed appropriate by the Secretary; and

'[B] in addition to core school curricula, additional coursework or training experiences focused on medical issues prevalent in underserved rural communities.

'[4] RESIDENCY PLACEMENT ASSISTANCE- Where available, the Program shall assist all students of the Program in obtaining clinical training experiences in locations with postgraduate programs offering residency training opportunities in underserved rural communities, or in local residency training programs that support and train physicians to practice in underserved rural communities.

'[5] PROGRAM STUDENT COHORT SUPPORT- The Program shall provide and require all students of the Program to participate in group activities designed to further develop, maintain, and reinforce the original commitment of such students to practice in an underserved rural community.

'[e] Annual Reporting- An eligible entity receiving a grant under this section shall submit an annual report to the Secretary on the success of the Program, based on criteria the Secretary determines appropriate, including the residency program selection of graduating students who participated in the Program.

'[f] Regulations- Not later than 60 days after the date of enactment of this section, the Secretary shall by regulation define 'underserved rural community' for purposes of this section.

'[g] Supplement Not Supplant- Any eligible entity receiving funds under this section shall use such funds to supplement, not supplant, any other Federal, State, and local funds that would otherwise be expended by such entity to carry out the activities described in this section.

'[h] Maintenance of Effort- With respect to activities for which funds awarded under this section are to be expended, the entity shall agree 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 entity for the fiscal year preceding the fiscal year for which the entity receives a grant under this section.

'[i] Authorization of Appropriations- There are authorized to be appropriated $4,000,000 for each of the fiscal years 2010 through 2013.'.

[m][1] Section 768 of the Public Health Service Act [42 U.S.C. 295c] is amended to read as follows:

'SEC. 768. PREVENTIVE MEDICINE AND PUBLIC HEALTH TRAINING GRANT PROGRAM.

'[a] Grants- The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Director of the Centers for Disease Control and Prevention, shall award grants to, or enter into contracts with, eligible entities to provide training to graduate medical residents in preventive medicine specialties.

'[b] Eligibility- To be eligible for a grant or contract under subsection [a], an entity shall be--

'[1] an accredited school of public health or school of medicine or osteopathic medicine;

'[2] an accredited public or private nonprofit hospital;

'[3] a State, local, or tribal health department; or

'[4] a consortium of 2 or more entities described in paragraphs [1] through [3].

'[c] Use of Funds- Amounts received under a grant or contract under this section shall be used to--

'[1] plan, develop [including the development of curricula], operate, or participate in an accredited residency or internship program in preventive medicine or public health;

'[2] defray the costs of practicum experiences, as required in such a program; and

'[3] establish, maintain, or improve--

'[A] academic administrative units [including departments, divisions, or other appropriate units] in preventive medicine and public health; or

'[B] programs that improve clinical teaching in preventive medicine and public health.

'[d] Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.'.

[2] Section 770[a] of the Public Health Service Act [42 U.S.C. 295e[a]] is amended to read as follows:

'[a] In General- For the purpose of carrying out this subpart, there is authorized to be appropriated $43,000,000 for fiscal year 2011, and such sums as may be necessary for each of the fiscal years 2012 through 2015.'.

[n][1] Subsection [i] of section 331 of the Public Health Service Act [42 U.S.C. 254d] of the Public Health Service Act is amended--

[A] in paragraph [1], by striking 'In carrying out subpart III' and all that follows through the period and inserting 'In carrying out subpart III, the Secretary may, in accordance with this subsection, issue waivers to individuals who have entered into a contract for obligated service under the Scholarship Program or the Loan Repayment Program under which the individuals are authorized to satisfy the requirement of obligated service through providing clinical practice that is half time.';

[B] in paragraph [2]--

[i] in subparagraphs [A][ii] and [B], by striking 'less than full time' each place it appears and inserting 'half time';

[ii] in subparagraphs [C] and [F], by striking 'less than full-time service' each place it appears and inserting 'half-time service'; and

[iii] by amending subparagraphs [D] and [E] to read as follows:

'[D] the entity and the Corps member agree in writing that the Corps member will perform half-time clinical practice;

'[E] the Corps member agrees in writing to fulfill all of the service obligations under section 338C through half-time clinical practice and either--

'[i] double the period of obligated service that would otherwise be required; or

'[ii] in the case of contracts entered into under section 338B, accept a minimum service obligation of 2 years with an award amount equal to 50 percent of the amount that would otherwise be payable for full-time service; and'; and

[C] in paragraph [3], by striking 'In evaluating a demonstration project described in paragraph [1]' and inserting 'In evaluating waivers issued under paragraph [1]'.

[2] Subsection [j] of section 331 of the Public Health Service Act [42 U.S.C. 254d] is amended by adding at the end the following:

'[5] The terms 'full time' and 'full-time' mean a minimum of 40 hours per week in a clinical practice, for a minimum of 45 weeks per year.

'[6] The terms 'half time' and 'half-time' mean a minimum of 20 hours per week [not to exceed 39 hours per week] in a clinical practice, for a minimum of 45 weeks per year.'.

[3] Section 337[b][1] of the Public Health Service Act [42 U.S.C. 254j[b][1]] is amended by striking 'Members may not be reappointed to the Council.'.

[4] Section 338B[g][2][A] of the Public Health Service Act [42 U.S.C. 254l-1[g][2][A]] is amended by striking '$35,000' and inserting '$50,000, plus, beginning with fiscal year 2012, an amount determined by the Secretary on an annual basis to reflect inflation,'.

[5] Subsection [a] of section 338C of the Public Health Service Act [42 U.S.C. 254m], as amended by section 5508, is amended--

[A] by striking the second sentence and inserting the following: 'The Secretary may treat teaching as clinical practice for up to 20 percent of such period of obligated service.'; and

[B] by adding at the end the following: 'Notwithstanding the preceding sentence, with respect to a member of the Corps participating in the teaching health centers graduate medical education program under section 340H, for the purpose of calculating time spent in full-time clinical practice under this section, up to 50 percent of time spent teaching by such member may be counted toward his or her service obligation.'.